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Application for Non-Residential Sewage Disposal System

  1. County Seal (color)
  2. Wyoming County Health Department
    Environmental Division
    5362 Mungers Mill Road, Silver Springs, NY 14550
    Telephone 585-786-8894
    Non-Residential Sewage Disposal System
  3. Reason for Permit*
  4. Type of Buisness*
  5. Source of Water*
  6. Food Service Kitchen
  7. Public Usage of Facility*
  8. Note * Payment may be made online by clicking the link or form must be printed and mailed to our office with appropriate fee
  9. Payments
    Make check payable to the Wyoming County Health Department:
    5362 Mungers Mill Road
    Silver Springs, NY 14550
    **Appointments may not be made until payment is recieved by this office.
  10. Property Owner Signature
  11. Leave This Blank:

  12. This field is not part of the form submission.