Do I need a notary for the Sewer/Water Adequacy Change of Use form?

No. The form has no notary block. The applicant completes Section A; it does not request an applicant signature or date.

How do I submit the Sewer/Water Adequacy Change of Use form?

Complete Section A and submit it to the Dutchess County Department of Health at 85 Civic Center Plaza, Suite 106, Poughkeepsie, NY 12601.

What information does the form ask for?

Section A requests applicant, owner, and project details, water and sewage information, and capacity worksheet data for existing or proposed uses.

Do I need to include supporting documents?

Some projects may require supporting documents, including floor plans, engineering plans, or engineering reports. The form also allows additional sheets or information as necessary.

Dutchess County, NY · Dutchess County

No notary required

Sewer/Water Adequacy Change of Use

This form lets an applicant or property owner provide Dutchess County Health Department with project and water and sewage details for a proposed change of use.

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

Applicants complete Section A with owner, project, water supply, sewage disposal, and capacity worksheet information, then submit the form to the Dutchess County Department of Health. The department uses Section B to record its capacity determination and any permits or engineering evaluation needed. Supporting materials, such as floor plans or engineering documents, may be required for some projects.

Who needs it

Applicants or property owners proposing a change of use at a property provide the project and system-capacity information requested in Section A.

How to submit it

Complete Section A and submit it to the Dutchess County Department of Health, 85 Civic Center Plaza, Suite 106, Poughkeepsie, NY 12601. The form lists [email protected] and 845-486-3404 for contact.

About notarization

This form has no notary block; the applicant completes Section A, and the form does not request an applicant signature or date.

How to submit this form

1
Download the Form
Download the Sewer/Water Adequacy Change of Use PDF.
2
Complete Section A
Provide applicant, owner, project, water supply, sewage disposal, and capacity worksheet information.
3
Gather Supporting Documents
Attach additional sheets or information as necessary; some projects may require floor plans or engineering documents.
4
Submit to the County
Submit the completed form to the Dutchess County Department of Health at the address shown on the form.

Frequently asked questions

Do I need a notary for the Sewer/Water Adequacy Change of Use form?: No. The form has no notary block. The applicant completes Section A; it does not request an applicant signature or date.
How do I submit the Sewer/Water Adequacy Change of Use form?: Complete Section A and submit it to the Dutchess County Department of Health at 85 Civic Center Plaza, Suite 106, Poughkeepsie, NY 12601.
What information does the form ask for?: Section A requests applicant, owner, and project details, water and sewage information, and capacity worksheet data for existing or proposed uses.
Do I need to include supporting documents?: Some projects may require supporting documents, including floor plans, engineering plans, or engineering reports. The form also allows additional sheets or information as necessary.

Need something notarized?

This Sewer/Water Adequacy Change of Use doesn’t need a notary, but if you have another Dutchess County form that does, a commissioned online notary can help.