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You may select more than one option.
This includes any dripping fixtures or toilets that "hang."
On-site owner consent form can be found here.
***This application is ONLY valid for 6 months upon submission***
e.g. (555) 555-5555
Find your tax parcel # on OPIS.
wastewater generated from other than human sanitary uses including, but not limited to: industrial uses (chemicals, pesticides, paints), food processing (excessive grease/oils), commercial uses (beauty salon, taxidermy, furniture refinishing)
e.g. 14 x 76
Please indicate what you are building. Will only apply if "Existing System Release Application" was checked at the beginning of this form.
Will only apply if "Existing System Re-Use Application" was selected at the beginning of the form.
A site plan must be submitted with this application. The site plan must show:
✔ Proposed Dwelling
✔ Property Lines (Side & Road Frontage)
✔ Well Location (if applicable)
✔ Additional Buildings (if applicable)
I acknowledge that my site plan must meet Planning and Zoning requirements and their Department reserve the right to deny my site plan and put a hold on my application.
By signing below, I acknowledge and understand that any information I submit to Pitt County Environmental Health is considered public information and may be released in a public record request. I certify that all information is true and correct to the best of my knowledge.
Please print full name.
* indicates a required field