Sewage System Construction Application Installing a new or replacement septic system, or hooking up to an existing septic system. Permit For*Please choose one from the menu (use down arrow for options): Sewage - New Construction ($250.00)Sewage - Existing/Replacement ($250.00)Sewage - Hook-up to Exisiting ($250.00)Sewage - Business/Migrant ($250.00)Sewage - renewal* within 6mo of expiring & no changes needed ($125.00)Home Owner's Name* First Last Home Owner's Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Owner's Phone #*Applicant's Phone #Applicant's Name: First Last Applicant's Mailing Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Applicant's Email Applicant's Fax #Property Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parcel ID# Lot Size County*CassVan BurenTownshipAlmenaAntwerpArlingtonBangorBloomingdaleCalvinColumbiaCovertDecaturGenevaHamiltonHartfordHowardJeffersonKeelerLa GrangeLawrenceMarcellusMasonMiltonNewbergOntwaPaw PawPennPine GrovePokagonPorterPorter (N)Porter (S)Silver CreekSouth HavenVolinaWaverlyWayneSection Subdivison Lot # Is this a single-family dwelling?*(If NO, please provide dwelling or business type on next line) Yes No Indicate dwelling type or business name Will you have or do you have a garbage grinder in the kitchen sink* Yes No Number of Bedrooms*Please enter a number from 0 to 500.Number of OccupantsPlease enter a number from 0 to 500.***SCALED DRAWING of Proposed Sewage System Location for NEW Construction(Drawing shall include dimensions to permanent landmarks and any known sources of contamination. Required for application submission and permit approval.)Max. file size: 50 MB.NOTE: Prior to this department performing any site evaluation that involves disturbing the ground surface, i.e., auger borings, probing, etc., the property owner(s) must contact MISS DIG to clearly identify any/all underground utilities. If the property owner(s) fails to notify MISS DIG, then the local public health department assumes no liability in the event of any damages occurring and the property owner shall bear all cost of repairs. NOTE: A Soil Erosion & Sedimentation Permit is needed when any soil is disturbed within 500’ of any water bodies, (i.e., lake, stream, pond, river, etc.), by contacting (269) 657-8241 (Van Buren County) or (269) 445-8641 ext 5 (Cass County).Applicant Signature*By typing your own name above you are voluntarily signing this document electronically, acknowledging and agreeing to its terms. CommentsThis field is for validation purposes and should be left unchanged.
