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 round trip (for a total of $1.12 one way) from our office in Blanding for ALL APPLICANTS.
**Please enter the number of miles from the site of recertification to our office in the quantity box below. This should ONLY be blank if you live within one mile of our office.

For Example, if the location of your inspection/recertification is 20 miles from our office please enter "20" in the Travel Surcharge quantity box below.
CLICK HERE to find the mileage from your property to our office for the travel surcharge. This will use your current location if you are at your property. If you are not, please enter your address instead.
Septic Recertification:   $75.00   Select:   Item Subtotal:  
$0.00
Well Recertification:   $75.00   Select:   Item Subtotal:  
$0.00
Travel Surcharge:   $1.12   Quantity:   Item Subtotal:  
$0.00
Total:
$0.00
 
Payment Information:
Processing Fee Rates:
Cards:2.5% ($1.50 min)
(1.5% surcharge for foreign cards)
eCheck:$0.75
Method of Payment:
 
  E-Check
 Update Name from Above
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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