Sterling, NY · Cayuga County
Application for a Variance Affidavit
This affidavit supports a request to the Cayuga County Board of Health Variance Committee for a sanitary code variance involving septic system inspection and pumping at a property.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
The affidavit gives the committee information about the property, why the residence is unoccupied, and when the septic tank was last pumped; the form says to attach the pumping receipt. The applicant also acknowledges that a variance condition may suspend the discharge permit and bar septic system use until inspection requirements are met and the Environmental Health Division is advised that occupancy has resumed or will resume. It is used in support of a requested variance from the Cayuga County Sanitary Code.
How to get this notarized
- 1
Download the Form
Get the Application for a Variance Affidavit from the Cayuga County document source.
- 2
Fill In the Details
Complete the property, vacancy, and septic pumping information, and attach the pumping receipt.
- 3
Book an Online Notary
Arrange a remote session with a commissioned online notary before signing.
- 4
- 5
Submit to the Committee
Send the notarized affidavit and receipt to the Variance Committee as directed.
Preview the form
The blank PDF straight from Sterling. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete the septic variance affidavit?
- Fill in the property town, tax map number, address, reason the residence is unoccupied, and septic pumping details. Attach the pumping receipt, then sign under oath before a notary.
- Do I need to attach a septic pumping receipt?
- The affidavit says a receipt for the septic tank pumping is attached. Include the receipt for the pumping described in the form.
- Can I sign this affidavit with a commissioned online notary?
- New York authorizes its commissioned online notaries to perform remote online notarizations. Book a session, appear on video, and sign when directed so the notary can administer the oath.
- Where do I submit the completed affidavit?
- The form is addressed to the Variance Committee of the Cayuga County Board of Health. Confirm submission instructions with the committee or the Cayuga County Health Department; confirm with the city, town or village if unsure.