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Application for Sewage Disposal Permit Waiver

  1. County Seal (color)

  2. Wyoming County Health Department
    Environmental Division
    5362 Mungers Mill Road, Silver Springs, NY 14550
    Telephone 585-786-8894

    Sewage Disposal System Permit Waiver

  3. Note

    This office recommends that prior to any development of vacant land a comprehensive site plan be established as to the placement of buildings and infrastructures including the well and wastewater disposal systems serving the property. With this being noted this office also recognizes that not all properties that are developed need potable water and wastewater disposal systems to serve them. As a result the requirement to submit an Application for Sewage Disposal Permit and subsequent percolation test may be waived by completing the following

  4. I hereby request that the Application for Sewage Disposal Permit be waived for the following property noting that there will be no potable water serving the proposed construction.

  5. Property Owner Signature

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  7. This field is not part of the form submission.