Central Michigan District Health Department

Application for Permit

Please fill out this application and click on the "Create Appliction" button at the bottom of the form.

Required fields denoted by a *
* To Construct:
System Type New Replacement
Septic System
Commercial Septic
Private Water Supply
Type III Water Supply
* County:
* Township/City:
* Section:
Subdivision:
Lot:
Fraction:
Town:
Range:
Permit Location:
* Property Tax ID#:
* Lot of Acreage Dimensions:
* Street Address:
* Directions to Site:
Issue Permit to:
* Owner's Name:
* Mailing Address:
* Telephone:
* Diver's License #:
* Date of Birth:
Type of Building
Residential
New Replacement
Age of System
# of Bedrooms:
Last Routine Tank Pumping (MM/DD/YYYY)
Proposed Basement Plumbing Fixtures: Yes No
 
Probable Cause of
Replacement
 
Commercial
Drains
Lavatories
Stools
Showers
Sinks
Total Daily Flow
Proposed Contractors
* Proposed Well Driller
* Proposed Excavator
Existing Well Information
Depth
Well Driller
Year Installed
Well to be Abandoned: Yes No