Forms and Applications
Below are all the forms you'll need throughout the cost share process. These forms are available in hard copy at the Wise County Health Department in Wise, the Lonesome Pine Soil and Water Conservation District office in Clintwood, Norton Town Hall, and Coeburn Town Hall.
If you only need a septic pump out, the Pump Out form is all you'll need to use. If you are having system failure or know you need repairs, you will need to fill out the Repairs and Installations form.
If you only need a septic pump out, the Pump Out form is all you'll need to use. If you are having system failure or know you need repairs, you will need to fill out the Repairs and Installations form.
Application for Pump Outs | |
File Size: | 134 kb |
File Type: |
Home Owner Application for Repairs and Installations | |
File Size: | 142 kb |
File Type: |
How it works | |
File Size: | 408 kb |
File Type: |
Homeowner Agreement | |
File Size: | 93 kb |
File Type: |
Reimbursement form | |
File Size: | 134 kb |
File Type: |