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San Juan County Health Department
735 S 200 W Suite 2, Blanding, UT 84511
Phone: (435) 587-3838
sanjuanpublichealth.org
Recertification For 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
Septic Recertification:
$78.00
Select:
Item Subtotal:
$0.00
Total:
$0.00
Payment Information:
Processing Fee Rates:
Cards:
2.5% ($1.50 min)
(1.5% additional service fee for foreign cards)
eCheck:
$0.75
Method of Payment:
Credit/Debit Card
eCheck
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:
Payment method will be collected on external device
Change Payment Method
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