Sewage Disposal System Installer License Application  


 

Note: * = required field
Oakland County Health Division as Required by Article XI
of the Oakland County Sanitary Code
You are applying as a New Sewage Disposal System Installer. As required by Article XI, you must attend & successfully pass the OCHD Onsite Sewage Disposal System Installer Licensing Class.
For license year ending December 31, 2021
Type: New License Application
Installer Address Same As         Mailing Address     Business Address
* Name
* Street Number
* Street Name
* City Name
* State Code
* Zip Code
* Phone Number
(9999999999)
Alternate Phone Number
(9999999999)
* Email ID
Mailing Address Same As         Installer Address     Business Address
* Name
* Street Number
* Street Name
* City Name
* State Code
* Zip Code
* Phone Number
(9999999999)
Alternate Phone Number
(9999999999)
Email ID
Business Address Same As         Installer Address     Mailing Address
Name
Street Number
Street Name
City Name
State Code
Zip Code
Phone Number
(9999999999)
Alternate Phone Number
(9999999999)
Email ID
Fee Information:
Application Fee $100.00
Enhanced Access Fee $5.50
Total Fee $105.50
I affirm that the above information is correct and that as a licensed onsite sewage disposal system installer I will comply with all regulations and requirements set forth by the Oakland County Sanitary Code and Oakland County Health Division as they relate to onsite sewage disposal systems.
By choosing to submit this form electronically, I certify and agree that by entering my name in the space below, I bind and legally obligate myself to the same extent as I would by signing my name on a printed paper version of this form.
Signed by
Date 10/27/2021
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