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2. SEWER PERMIT REQUIREMENTS:

   FEES: (non­refundable) $20.00 **NO BUILDING PERMITS WILL BE ISSUED WITHOUT A SEWER DESIGN

   Step 1: Fill out form in it’s entirety. Contact Sue Black prior to installation to obtain a 911 address at 605-578­-4464.

   Step 2: A septic system design letter from a Registered Professional Engineer is required and he/she must identify all of the requirements in the Lawrence County Ordinance Chapter 9 and the SDCL Chapter 34A­1 and SD DENR Regulations; Individual and Small On­Site Wastewater Systems Specifications, Chapter 74:03:01.  The design must be stamped and signed by the Professional Registered Engineer.

   Step 3: Septic System State Licensed Installer Contact www.state.sd.us or 605­-773-3351. A septic system must be installed by a State Licensed Installer. Must meet all requirements listed under Chapter 9.

   Step 4: Sewer Inspection Certificate All systems shall be inspected by the Engineer prior to being covered. An installation report shall be completed and returned to the Planning Dept. no more than 30 days after the inspection has taken place. Must meet all requirements listed under Chapter 9.

4. APPLICANT/OWNERSHIP INFORMATION:
6. Name*
7. Type of Permit*

   1. New Septic System
   2. Renovated Septic System
9. Mailing Address*
11. City*
12. State*
13. Zip*
15. Phone*
16. Email
20. Project Address*
21. Parcel Number*
23. Legal Description*
25. Flood Hazard Area (April 17, 2012)*

    If property is located in a flood plain, a Flood Plain Development Permit will also need to be obtained.

    1. Yes
    2. No
26. FEMA Panel Number

28. PLEASE MAKE CHECK’S PAYABLE TO LAWRENCE COUNTY TREASURER.  Please allow a minimum of five ( 5) working days to process. This permit expires after two (2) years if there is no installation of the Septic System per the design of the Engineer

30. If the signatory below is someone other than the property owner, the signatory represents and warrants they have full authority to sign this permit on behalf of the property owner and to bind the owner to all terms and conditions herein.
32. I hereby apply for the above sewage disposal system permit and acknowledge that this permit does not guarantee, warrant or in any way insure the operation, reliability or longevity of said system, the risk of which is strictly that of the applicant/owner.
34. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
36. Electronic Signature
37. Date*
    Date
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field