What information does the form ask for?

It requests property identification and address details, whether the property borders Owasco Lake or Little Sodus Bay, reasons for the request, and relevant contact information and signatures.

Do I need a notary for the Septic System Variance Request Form?

No. The form calls for signatures and a date, but does not require notarization or identify a notarized attachment.

Cayuga County, NY · Cayuga County

No notary required

Septic System Variance Request Form

Property owners or buyers use this form to ask the Cayuga County Health Department for a septic inspection, inspection extension, or septic tank pump-out variance.

At a glance

Issued by: City of Cayuga County · Cayuga County, Cayuga County, New York
Notarization: Not required: file this form without a notary.
Official source: cayugacounty.gov
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This form lets a requester ask the Cayuga County Health Department to waive or extend a property transfer inspection, routine inspection, or septic tank pump-out. It asks for the property's tax map number, town, address, whether it borders Owasco Lake or Little Sodus Bay, reasons for the request, and relevant owner, buyer, or seller contact details and signatures. The form says incomplete requests will be returned.

Who needs it

A property owner or buyer seeking a variance for a septic inspection or tank pump-out can use this form to make the request.

How to submit it

Send the completed form to the Cayuga County Health Department, Environmental Division, 8 Dill Street, Auburn, NY 13021.

About notarization

This document is signed without a notary; the form requests signatures and a date, and does not identify a notarized attachment or related step.

How to submit this form

1
Download the Form
Download the Septic System Variance Request Form.
2
Complete the Request
Enter the property details, select the requested variance, explain the reasons, and fill in applicable contact information.
3
Sign and Date
Provide the signatures requested on the form and enter the date.
4
Send the Form to the County
Send the completed form to the Cayuga County Health Department, Environmental Division, 8 Dill Street, Auburn, NY 13021.

Frequently asked questions

What can I request with the Septic System Variance Request Form?: You can ask the Cayuga County Health Department to waive or extend a property transfer inspection, routine inspection, or septic tank pump-out.
What information does the form ask for?: It requests property identification and address details, whether the property borders Owasco Lake or Little Sodus Bay, reasons for the request, and relevant contact information and signatures.
Do I need a notary for the Septic System Variance Request Form?: No. The form calls for signatures and a date, but does not require notarization or identify a notarized attachment.
How do I submit the Septic System Variance Request Form?: Send the completed form to the Cayuga County Health Department, Environmental Division, at 8 Dill Street, Auburn, NY 13021.

Need something notarized?

This Septic System Variance Request Form doesn’t need a notary, but if you have another Cayuga County form that does, a commissioned online notary can help.