Utilities Verification Request
Public Utilities/Potable Water Wells/Septic Systems
Permit Number
Date
Job Name
Job Address
Applicant
You have received this form to provide verification of potable water and sanitary sewer/septic availability for permitting purposes
when serviced by public and/or private providers other
than Pinellas County Utilities. The required documentation for each
provider type is listed below. This verification documentation is required by the Florida Building Code-Plumbing and State
Statute. It must be submitted before
a permit will be issued.
Municipal Potable Water
If this Submit this
New Account Provide a receipt or letter from the provider that meter, BFD and impact fees (if any) have been
paid.
Existing Account Provide a receipt or letter from the provider that the account is existing. If there will be a change in
the meter size and/or backflow devices are to be installed, provide a receipt or letter showing that
fees (if any) have been paid.
Private Potable Well
If this Submit this
New Potable Well Provide final inspection documentation and bacteriological release for new potable water well.
Existing Potable Well Provide calculations on plans that existing well is sized to supply additional demand.
Well Permitting - SWFWMD 7601 US Hwy. 301 Tampa, FL 33637-6759 (Google map) Phone: (813) 985-7481
Municipal or Private Sanitary Sewer
If this Submit this
New Account Provide a receipt or letter from the provider that sewer tap and impact fees (if any) have been paid.
Existing Account Provide a receipt or letter from the provider that the account is existing. If there will be additional
plumbing fixtures added, provide a receipt or letter showing that fees (if any) have been paid.
Septic Systems
If this Submit this
New System Provide a copy of the septic system permit from the Florida Department of Health. Living area and
number of bathrooms must match on DOH and Building permits.
Existing System Provide a copy of the septic system upgrade permit from DOH or approval for existing system to
remain for any of the following conditions:
Any increase in building square footage
Addition of a bathroom(s) with or without an increase in building square footage
Any change in occupancy or use
Installation of a pool
Installation of a porch, wood or concrete pad/patio/deck or driveway
Installation of a shed, storage building or other detached structure
Any permanent construction that reduces the available square footage of the parcel for septic
system replacement or expansion.
Septic Demo Provide septic demolition permit when changing to municipal sewer for a septic system or from
demolition of a building on a septic system.
Septic Permits – Florida Department of Health 8751 Ulmerton Road Largo, FL 33771( Google Map )727-538-7277 ext# 7960
Revised 12/8/2014 DSH
