Application to Install an On-Site Sewage Disposal System
$150.00

NOTE: Your application will be processed once Part 2 has been submitted to Department of Public Safety, Technical Inspection Services.

* Mandatory fields
Section 1: Applicant Information
* Application Date:
* Name of Licensee
* License Number
Mailing Address of Licensee
* Street:
* City, Town or Village:
* Province:
* Postal Code:
* Telephone (Work):
  Telephone (Home):
  Telephone (Cell):
  Preferred Language: French   English
Section 2: Property Information
* Property Location:
(i.e: detailed directions including
landmarks, flags, closest civic #)
  Subdivision Name:
* PID:
* Property Owner:
  Lot #:
Section 3: Building Information
* Type of Building
Single Family
Other:
* Number of Bedrooms (excluding basement)
1
2
3
Other:
* Are there other buildings with on-site sewage services on this property?
No
Yes
If yes, please specify:
Section 4: Lot Dimensions (include units of measurement)
*  Total Area:
*  Lot Dimensions:
Section 5: Water Supply
* Water Supply:(please check all that apply)
drilled well
municipal
dug well
no well present
Other
Section 6: Type of Installation
* Please select one of the following:
New
Replacement Full Replacement
  Septic tank only
  Disposal field only
Repair (specify type)
Note: Test pit must be left open ready for assessment until the Licensee is in receipt of an approval or refusal.
TYPING IN YOUR NAME AND ELECTRONICALLY SENDING THIS FORM TO SERVICE NEW BRUNSWICK CONSTITUTES YOUR ELECTRONIC SIGNATURE.
* Signature of Licensee * Date (mm/dd/yyyy)
(* Note: Signature of property owner is required in Part 2 of the application)
IF YOU HAVE ENTERED ALL RELEVANT INFORMATION, CLICK ON "ADD TO BASKET"
(ONLY ONCE) TO SUBMIT YOUR APPLICATION.
IF YOU WISH, PRINT A COPY FOR YOUR FILES USING YOUR BROWSER'S PRINT FUNCTION.


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