Forms • Story County, IA • CivicEngage

Story County Septic Contractor License Application

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Company Name:*
Company Address:*
City:*
State:*
Zip/Postal Code:*
Office Phone: (xxx)xxx-xxxx*
Office Email:
Certified Installers of Onsite Wastewater Treatment System (CIOWTS) Affiliated with Your Company
Name:*
Cell Phone: (xxx)xxx-xxxx*
Email:
CIOWTS #:*
Date Certified: (xx/xx/xxxx)*
Date Expires: (xx/xx/xxxx)*
Name:
Cell Phone: (xxx)xxx-xxxx
Email:
CIOWTS #:
Date Certified: (xx/xx/xxxx)
Date Expires: (xx/xx/xxxx)
Name:
Cell Phone: (xxx)xxx-xxxx
Email:
CIOWTS #:
Date Certified: (xx/xx/xxxx)
Date Expires: (xx/xx/xxxx)
Story County Environmental Health Department requests permission to list your company name and contact information on the Environmental Health Department website's list of licensed septic contractors. The list will be updated routinely to indicate who is eligible to install or repair septic systems in Story County. As a government agency, we do not promote private businesses.
Permission Granted
Permission Denied

* indicates required fields.