What does the Application for Extension of Approval do?

It lets a property owner request an extension of an original Dutchess County Department of Health approval, if the approval meets the standards required for an extension.

Who completes this application?

The owner of the property covered by the original approval completes the form and certifies that the information provided is correct.

Do I need a notary for the Application for Extension of Approval?

No. The form has an owner’s certification with a signature and date, but no notary block or notarized attachment is indicated.

How do I submit the Application for Extension of Approval?

Submit the completed form to the Dutchess County Department of Health at the address listed on it. Include the non-refundable fee: $200 for the first lot and $125 for each additional lot.

Dutchess County, NY · Dutchess County

No notary required

Application for Extension of Approval

Property owners use this application to ask the Dutchess County Department of Health to extend an existing approval for a property.

At a glance

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

What this form is

This application lets a property owner request an extension of an original Dutchess County Department of Health approval, subject to the applicable standards. It asks for the owner’s contact information, property and parcel details, whether the property has changed since approval, and the owner’s certification. The form instructs applicants to submit it with a non-refundable fee of $200 for the first lot and $125 for each additional lot.

Who needs it

A property owner seeking an extension of an original Dutchess County Department of Health approval should complete this application.

How to submit it

Submit the completed application to the Dutchess County Department of Health at 85 Civic Center Plaza, Suite 106, Poughkeepsie, NY 12601. The form requires a non-refundable fee of $200 for the first lot and $125 for each additional lot.

About notarization

This document is signed without a notary; the owner simply signs and dates the certification.

How to submit this form

1
Download the Application
Download the Application for Extension of Approval PDF.
2
Complete Sections A, B, and C
Fill in the owner and property information, describe any changes since approval, and sign and date the owner’s certification.
3
Prepare the Fee
Include the non-refundable fee of $200 for the first lot and $125 for each additional lot.
4
Submit to the County
Submit the application and fee to the Dutchess County Department of Health at the address shown on the form.

Frequently asked questions

What does the Application for Extension of Approval do?: It lets a property owner request an extension of an original Dutchess County Department of Health approval, if the approval meets the standards required for an extension.
Who completes this application?: The owner of the property covered by the original approval completes the form and certifies that the information provided is correct.
Do I need a notary for the Application for Extension of Approval?: No. The form has an owner’s certification with a signature and date, but no notary block or notarized attachment is indicated.
How do I submit the Application for Extension of Approval?: Submit the completed form to the Dutchess County Department of Health at the address listed on it. Include the non-refundable fee: $200 for the first lot and $125 for each additional lot.

Need something notarized?

This Application for Extension of Approval doesn’t need a notary, but if you have another Dutchess County form that does, a commissioned online notary can help.