St Clair County Health Center

ST. CLAIR COUNTY SEPTIC PERMIT APPLICATION
SINGLE FAMILY FEE: $90.00		COMMERCIAL FEE: $125.00			FEE PAID: YES____ NO _____
DATE: __________________
NAME:				DATE OF BIRTH OR SS#:

MAILING ADDRESS:

CITY, STATE AND ZIP:

SITE ADDRESS:					CITY AND ZIP:

DIRECTIONS TO SITE:


PHONE NUMBER:	HOME:				WORK:

		HOMEOWNER INFORMATION

NEW SYSTEM				WATER SUPPLY
REPAIR SYSTEM				NO. OF ACRES
TANK REPLACEMENT				NO. OF	BEDROOMS
LATERAL FIELD MOD				NO. OF BATHROOMS
LAGOON MOD				NO. OF OCCUPANTS


I AUTHORIZE			TO ACT AS MY REGISTERED INSTALLER WHILE
INSTALLING A WASTEWATER TREATMENT SYSTEM IN ACCORDANCE WITH ST. CLAIR
COUNTY WASTEWATER TREATMENT ORDINANCE.


I CERTIFY THAT THE ABOVE INFORMATION ON THIS FORM IS TRUE AND CORRECT AND
UNDERSTAND THAT FALSE STATEMENTS ARE PUNISHABLE UNDER MISSOURI LAW.

OWNER/REPRESENTATIVE SIGNATURE:

THE NUMBER OF BEDROOMS IS COMPARED TO THE NUMBER OF OCCUPANTS LIVING IN
THE HOUSEHOLD WHEN CALCULATING LATERAL FIELD SQUARE FOOTAGE. WHICH
EVER OF THE FOLLOWING IS GREATEST WILL BE USED:
GALLONS PER DAY PERSON VERSUS GALLONS PER DAY PER BEDROOM FOR FOOTAGE
DETERMINATION.

NEW CONSTRUCTION:
AN INSTALLERS PLAN MUST BE ATTACHED WITH A SOIL MORPHOLOGY REPORT ON NEW
CONSTRUCTION.
REPAIRS:
MUST HAVE PLANS TO MEET THE MINIMUM STANDARDS.

Septic Permit Application