Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Cole County Health Department On-Site Sewage Disposal System Construction Permit Application

  1. New Construction?*

  2. Repair of Existing System?*

  3. Residence?*

  4. Residence Type*

  5. Business?*

  6. Business Type

  7. Street Address

  8. Mailing Address Same as Physical Address?*

  9. Water Supply*

  10. Acres

  11. Quantity

  12. Type of Private Well*

  13. Whirlpool?

  14. Dishwasher?*

  15. Laundry Facility*

  16. Garbage Disposal?*

  17. Water Softener*

  18. Type of On-Site Sewage System

  19. Sewage/Pump Tank Information*

    If Applicable is selected additional questions will display.

  20. Gallons

  21. Quantity

  22. Is Tank Aerated?*

  23. Is System Pumped or Dosed?*

  24. Gallons

  25. Feet

  26. Feet

  27. Feet

  28. Feet

  29. Feet

  30. Sewage Field and Set Back Distance Information*

    If Applicable is selected additional questions will display.

  31. Square Feet

  32. Type of Distribution*

  33. Geoflow, Pipe, & Gravel etc.

  34. Inches

  35. Inches

  36. Feet

  37. Quantity

  38. Feet

  39. Feet

  40. Feet

  41. Feet

  42. Feet

  43. Feet

  44. Lagoon Information

    If Applicable is selected additional questions will display.

  45. Feet (Length x Width)

  46. Feet

  47. Square Feet

  48. Is Artificial Liner or Imported Clay Required?*

  49. Feet

  50. Feet

  51. Feet

  52. Feet

  53. Feet

  54. Feet

  55. Feet

  56. A site diagram design drawing MUST be attached and submitted with this form.

  57. SIGNATURE REQUIRED

  58. DATE REQUIRED

  59. Please contact the Cole County Health Department Environmental Staff with any questions at 573-636-2181.

  60. Office Use Only

  61. Application Approved?

    Office Use Only

  62. Office Use Only

  63. Office Use Only

  64. Office Use Only

  65. Leave This Blank: