Caroline County Health Department
Division of Environmental Health
403 S 7th Street, P.O. Box 10, Denton, MD 21629
Hours 8-5p.m., M-F; Phone: 410/479-8045 FAX: 410/479-4187
[E/H HOME PAGE] [FEE SCHEDULE
AND APPLICATIONS] [QUESTIONS-ANSWERS]
SANITARY CONSTRUCTION AND/OR SEWAGE HAULER LICENSE APPLICATION
DIRECTIONS: Complete items A-L, attach fee and certificate of
liability insurance naming Caroline County Health
Department as a certificate holder to application.
[click here for copy
of County Regulations]
A. Name of business:____________________________________________________________
B. Owner of business
FIRST NAME, LAST NAME:___________________________________________________________
C. Mailing address:_______________________________________________________________
(Street addres or P.O. Box number, City, State, ZIP--this is where permit
and renewal applications will be sent.
D. PHONES: Day:__________________________
Fax:__________________________________ Cell:____________________________
E. TYPE OF LICENSE (select ONE of the following):
I___Installer only ($250 fee) H___Hauler only ($250 fee) H/I___Both Septage Hauler and Septic System Installer ($500 fee)
Please make check or moneyorder payable to CAROLINE COUNTY HEALTH DEPARTMENT
F. List on back mechanical equipment you own to install and/or pump septic systems (make/model number/year):
G. Do you own a surveyors level?___
H. List on back other licenses (past or current) you hold or have held relating to sanitary construction.
I. Submit list of individuals in your firm who you are authorizing to sign on your behalf for permits
to construct on-site septic systems (include typed names and their signatures, too)
J. Describe on back any experience you have relating to sanitary construction and/or hauling septage.
K. If hauler, attach copy of most recent truck inspection (if inspected in another Maryland county).
If your truck(s) not inspected by Maryland county, call 410/479-8045 to schedule an inspection--this application, insurance and fee must be received before or brought in at the time of inspection.
Written agreement to dump waste at approved facility required, too.
L. Signature:______________________________________ Date:_____________________
Leland Spencer, M.D., Health Officer
Comments to: belindar@dhmh.state.md.us $____________Paid on________________ Receipt#_________________ ID#______________
CFW 2005, June/br