San Juan County Public Health
             
San Juan County Health Department
735 S 200 W Suite 2, Blanding, UT 84511
Phone: (435) 587-3838

Recertification For Well / Septic

Date
Home Owner's Name
Location of Home
Contact Phone Number
Contact Person if different than owner

Approval letter to go to the following:

Establishment Information
Organization Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
 
Select Requested Services
*There will be a travel surcharge of $0.56 per mile if the inspection is more than 15 miles from Blanding or Monticello.
**If this applies to you, please enter the number of miles from Blanding or Monticello (whichever is closer) in the quantity box below. Please do not enter anything if you are less than 15 miles from either Blanding or Monticello.
For Example, if your inspection is 20 miles from Monticello please enter "20" in the quantity box below.
Septic Recertification:   $75.00   Select:   Item Subtotal:  
$0.00
Well Recertification:   $75.00   Select:   Item Subtotal:  
$0.00
Bacteriological Water Test ONLY:   $30.00   Select:   Item Subtotal:  
$0.00
Travel Surcharge:   $0.56   Quantity:   Item Subtotal:  
$0.00
Total:
$0.00
 
Payment Information:
Processing Fee Rates:
Cards: 2.5% ($1.50 min)
(4% for foreign cards)
eCheck (ACH): $0.75
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
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