Liquid Waste Operator

    Required Contact Information

    Contact Information

    Services Provided

    Please select ALL types of liquid waste services provided by the business entity:

    Septic Pumping
    Portable Chemical Toilets
    Vault Privy (CXTs) Pumping
    Septic Installment
    Holding Tank Pumping
    Septic Tank Inspections
    Septic Tank Locating
    Grease Traps
    Other (describe below)

    Collection Vehicle Information

    Please fill out the following information for each liquid waste collection vehicle. The first vehicle
    has a permit fee of $70. Any additional collection vehicles will be charged a permit fee of $35
    each. Please use an additional form as needed.

    Vehicle 1 ($70 Fee):

    Vehicle 2 ($35 Fee):

    Vehicle 3 ($35 Fee):


    Vehicle 4 ($35 Fee):

    Vehicle 5 ($35 Fee):

    Vehicle 6 ($35 Fee):


    Counties Served

    Please select ALL of the applicable counties where collection, storage, or disposal of liquid waste occurs by the business entity:

    Box Elder County
    Cache County
    Rich County

    Disposal Site Information

    In the following table, please list the name and address of all liquid waste disposal sites used:

    Facility 1

    Facility 2

    Facility 3

    Facility 4


    Surety Bond Information

    A surety bond is currently considered optional. Please indicate below whether the business
    entity listed in this application wishes to provide documentation of a surety bond:


    If “YES” please attach surety bond documentation to this application.

    Digital Signature

    By typing your name below, you are signing this form electronically. You agree to, and understand, all the information you are submitting: