Short Term Rental Inspection Application – Van Buren Cass District Health Department

Complete for the inspection of an existing well or septic system for short term rental propoerty.

Request for:*
- Short Term Rental – Well & Sewage Inspection ($200.00)
- Short Term Rental – Sewage Inspection Only ($125.00)
- Short Term Rental – Well Inspection Only ($150.00)
Type*
- Duplex
- Business
- Single Family Dwelling
Septic Tank Size (fillable gallons)*
Please note: You are responsible for uncovering the septic tank lid. Tank should not be pumped prior to inspection.
Owner's Name*
Owner's Address*
Street Address Address Line 2 City State ZIP Code
Owner's Phone #*