**This Form Must Be Completed By The Property Owner**
Application for Septic Permit

 New Construction ____           OR           Repair ____           OR           Expansion ____

Residential ____          OR           Commercial ____

Required Documents: Installer’s Application ____ Legal Description of Property ____

                                         Floor Plans w/ Elevations ____ Plot Plan of Site ____ Installer’s Drawing ____

                                         Site Evaluation ____ Flood Plain Designation Yes/ No

 Water Source: Public ____     Semi-Public ____     Private ____

# Bedrooms: ____           # Bathtubs Over 125 gallons: ____

 Property Owner/ Applicant Name: __________________________________________________________

Mailing Address: _______________________________________________________________________

City/State/Zip: _________________________________________________________________________

Phone: ___________________________________________ Alt. Phone: _________________________

 Site Address: __________________________________________________________________________

Subdivision Name: __________________________________ Lot #: _____________________________

Parcel #: __________________________________ Township: _________________________________

Installer Name: _____________________________ Installer Phone: _____________________________

Installer Address: _______________________________________________________________________

I, the undersigned applicant, understand that I alone am responsible for the proper construction, maintenance and repair of the on-site sewage disposal system for which I have applied. An inspection of the system will be completed prior to backfilling by notifying the Morgan County Health Department. This permit is valid 2 years from the date of issue and is nontransferable.

 Signature: ________________________________________ Date: ______________________________

I, ________________________________, affirm under the penalties of perjury that my home is considered to be a ____ (#) bedroom home, as described in the bedroom definition* and accepted by the Morgan County Health Department. I understand that my septic system has been issued and sized correctly for my home in regard to the number of bedrooms and large bathtubs. I understand that if my septic system is not in compliance with the permit issued the permit will be null & void.

Signature of Property Owner: ________________________ Date: _______________________________

 *Bedroom: Any room which may be advertised or implied, reasonably perceived or potentially easily converted to a bedroom. Such rooms may include a closet and may be adjoined to a hallway or location in close proximity to other bedrooms and a bathroom. Such rooms should contain an area approved for egress or rescue. Such window or door is required to have a minimum net clear opening of 5.7 square feet. Sill height shall not be more than 44 inches from the floor with a minimum net clear opening height of 24 inches and minimum width of 22 inches. (Per Morgan County Ordinance 4-3-3.1)