**Website Redesign** Story County Website Redesign Survey Read On...

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616

Agendas & Minutes

Employment

How Do I...?

County Offices

E-Services

Employee Intranet

Social Networking

Farm Watch

The C2C Plan

Privacy Notice

Crisis Assistance

Story County Septic Contractor License Application

Leave This Blank:

Company Name:*
Company Address:*
City:*
State:*
Zip/Postal Code:*
Office Phone: (xxx)xxx-xxxx*
Office Email:
Certified Installers of Onsite Wastewater Treatment System (CIOWTS) Affiliated with Your Company
Name:*
Cell Phone: (xxx)xxx-xxxx*
Email:
CIOWTS #:*
Date Certified: (xx/xx/xxxx)*
Date Expires: (xx/xx/xxxx)*
Name:
Cell Phone: (xxx)xxx-xxxx
Email:
CIOWTS #:
Date Certified: (xx/xx/xxxx)
Date Expires: (xx/xx/xxxx)
Name:
Cell Phone: (xxx)xxx-xxxx
Email:
CIOWTS #:
Date Certified: (xx/xx/xxxx)
Date Expires: (xx/xx/xxxx)
Story County Environmental Health Department requests permission to list your company name and contact information on the Environmental Health Department website's list of licensed septic contractors. The list will be updated routinely to indicate who is eligible to install or repair septic systems in Story County. As a government agency, we do not promote private businesses.
Permission Granted
Permission Denied

* indicates required fields.