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OSTDS Forms

Environmental Health

  •  239-690-2100
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    Fax

    239-690-2101
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    Mailing Address

    2295 Victoria Avenue, #206 

    Fort Myers, FL 33901 

    ____________________ 

    TTY users can contact us through Florida Relay by dialing 7-1-1 or one of the other Relay Toll Free Numbers. 

DOH-Lee Forms and Fillable Forms 

Credit Card Authorization Form

Application for Abandonment Permit (crush/fill septic tank) (fillable)

Application for Construction Permit (new system, repair, existing, modification) (fillable)

Business Survey (for operating permit) (fillable)

Deed Notice for PBTS systems

Existing System and System Repair Evaluation (fillable)

Initial Inspection Request Form

Letter of Authorization for new/repair system applications

Operating Permit Application (fillable)

Utility Easement Agreement for Duplexes

Variance Application (fillable)

All Other OSTDS Forms: 

DH 4012, Application for Septage Disposal Service Permit, Temporary System Service Permit, Septage Treatment and Disposal Facility, Septic Tank Manufacturing Approval (01/92)

DH 4012A, Agricultural Use Plan (08/09)

DH 4014, Septic Tank Cleaning Service and Temporary Privy Service Inspection Report (06/98)

DH 4015 (page 1), Application for Onsite Sewage Treatment and Disposal System Construction Permit - Application (08/09)

DH 4015 (page 1) pdf form

DH 4015 (page 2), Application for Onsite Sewage Treatment and Disposal System Construction Permit - Site Plan (08/09)

Site Plan Instructions

DH 4015 (page 3), Site Evaluation and System Specifications (08/09)

DH 4015 (page 3) pdf form

DH 4015 (page 4), Existing System and System Repair Evaluation(08/09)

DH 4015 (page 4) pdf form

DH 4016 (page 1), Construction Permit (08/09)

DH 4016 (page 3), System Repair Certification (08/09)

DH 4016 (page 3) pdf form

DH 4066, Application for Maintenance Service Permit (02/10)

DH 4081, Application for Onsite Sewage Treatment and Disposal System Operating Permit (includes DH 4081A, Assessment of Waste Handling and Business Activities) (10/96)