Siskiyou County, CA · Siskiyou County
Environmental Health Water and Sewer Clearance
This clearance form accompanies a county Planning Department application and gives Environmental Health information to review a proposed project’s water and wastewater systems.
At a glance
- Issued by
- City of Siskiyou County · Siskiyou County, Siskiyou County, California
- Notarization
- Not required: file this form without a notary.
- Official source
- siskiyoucounty.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Applicants must include this form with every application packet submitted to the County Planning Department, regardless of the proposed sewer or water supply; applications will not be accepted without it. It asks for project and applicant details, parcel and location information, and a project description. Environmental Health uses the form to document whether it has adequate information to review wastewater disposal and water supply; its signature does not approve or deny the project.
Who needs it
Anyone submitting an application packet to the County Planning Department must include this form, regardless of the project’s sewer or water supply.
How to submit it
Include the completed form in the application packet submitted to the County Planning Department. For questions about the form, contact Environmental Health at (530) 841-2100.
About notarization
This document is signed and dated without a notary; it requires applicant and Environmental Health representative signatures, with no notarized or sworn attachment identified.
How to submit this form
- 1
Download the Form
Download the Environmental Health Water and Sewer Clearance form.
- 2
Complete the Project Information
Provide the applicant and project details, including the project description, parcel number, location, and water and sewer information.
- 3
Sign and Date the Form
Sign and date the certification stating that the project description matches the one submitted to the County Planning Department.
- 4
Include It With Your Application
Include the form in the application packet submitted to the County Planning Department; the county says applications will not be accepted without it.
Frequently asked questions
- What is the Environmental Health Water and Sewer Clearance form for?
- It provides Environmental Health with project, wastewater disposal, and water supply information for review as part of an application packet submitted to the County Planning Department.
- Who must include this form with an application?
- Applicants must include it with every application packet submitted to the County Planning Department, regardless of the type of sewer or water supply.
- Do I need a notary for the Environmental Health Water and Sewer Clearance form?
- No. The applicant signs and dates the form, and an Environmental Health representative also signs it. No notarized or sworn attachment is identified.
- How do I submit the Environmental Health Water and Sewer Clearance form?
- Include the completed form in the application packet submitted to the County Planning Department. Contact Environmental Health at (530) 841-2100 with questions about the form.