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Renewal Application - License to Install or Clean an On-site Wastewater Treatment System

2. Your Installers/Cleaners license will expire on December 31, 2021. The fee to renew your license is $35.00. If you wish to renew your license with Tri-County Health Department (TCHD), please use the link below to complete the application. Upon receipt of the completed application and certification, we will email you an Annual License Renewal Fee invoice for $35. Please upload a copy of your NAWT Certification if you have it and/or copies of contracts with disposal sites.

6. TCHD License (PI#)
8. Billing Account (AR#)
10. First Name
11. Last Name
13. Company Name*
14. Phone Number
16. Business Address*
18. Unit/Suite/Bldg
20. City*
21. State*
22. Zip*
24. Email Address*
26. Name of Applicant (please print)*
27. Date*
    Date
29. Upload Forms (Ex: NAWT Installer Certification)
    Note for Cleaners: If you would rather upload a copy of the contract of all sites used in the last year and to be used this year for disposing of pumpings, then do so here, just make sure it has your name and business on it.
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field