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Workman's Compensation Insurance Form
(required for Food
Facility licensure) |
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Sanitary Survey Application |
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Burning Permit Application |
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Please fill out the burning permit application down
to the double lines. Include all requested
information. Fee is $50.00. No application will be
accepted without payment and completely filled out.
Your site must be a minimum of 200' from the nearest
habitable dwelling and 200' off the road to qualify
for a burning permit. |
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Permanent Food
Service Facility Application |
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Please fill out application completely. Enclose
check for $300.00 for high and medium facilities;
low facilities will be $200.00. There is no charge
for non-profit organizations. |
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Temporary Food Service
Facility Application |
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Please fill out application completely. There is a
fee of $60.00. There is no charge for non-profit
organizations. |
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Freedom of
Information Act |
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Please fill out form completely. Please be specific
in indicating the records you wish to review and/or
copy. There will be a fee of $0.25 for each page
copied. Requests that take more than 2 hours to
process, will be charged for employee time. |
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Irrigation Well
Application |
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Please fill out the application for an irrigation
well, and sign it. Fee is $160.00. No applications
will be accepted without payment. This well can not
be used as a drinking water source. |
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Replacement Well
Application |
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Please fill out the application for a replacement
well for your property and sign it. Also show a
basic site plan in the area provided with home,
existing buildings on property. Fee is $160.00
and includes 5 water samples. (Additional water
samples will be billed at $10 each). |
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Land Evaluation
Application |
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Please fill out the application for a land
evaluation. The property owner must sign giving
permission to enter on the property. We need all the information
including tax map and parcel number. Subdivision
name (if applicable) and how many lots you are
proposing. Rates for land evaluation are $300.00 per
lot and $50.00 for each piezometer installed (health
dept. installation). Sewage reserve area
modification greater than 30%, fee is $300.00, if
less than 30% fee is $150.00. Applications will not
be accepted with incomplete information or without
the required fee. Land evaluations can be an
expensive and time consuming process. Other agencies
may also be involved in the subdivision of land,
including Planning and Zoning. For all those
interested in applying we recommend getting the
advice of a competent professional before applying
for a land evaluation.
Re-evaluation of previously approved lots (not
previously platted), is $150.00. |
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Replacement Sewage
System |
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Please fill out the application for a replacement
sewage system for your property and sign it. Also show a
basic site plan in the area provided with home,
existing buildings on property. Fee is $225.00
for replacement of tank and drainfield. $100.00 to
replace tank only. (Click
here for Application for Tank Only) |
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Water Sample
Application |
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Please fill out the application. Please be sure to
indicate what you want the water tested for. Water
sampling fee is $50.00 payable to Wicomico County
Health Department. A separate check should be made
payable to Salisbury Branch Laboratories for
analyzing the water. Listed below is the charge for
each individual test. You may mail this check along
with the water sampling fee. If you have a
physician's note requesting water to be tested for a
certain item there is no charge for analyzing the
water. Please be sure to attach note to this
application. |
