Form CEP-1 "Application for a Sewage Tank Pumper Permit" - Alabama

What Is Form CEP-1?

This is a legal form that was released by the Alabama Department of Public Health - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2013;
  • The latest edition provided by the Alabama Department of Public Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CEP-1 by clicking the link below or browse more documents and templates provided by the Alabama Department of Public Health.

ADVERTISEMENT
ADVERTISEMENT

Download Form CEP-1 "Application for a Sewage Tank Pumper Permit" - Alabama

Download PDF

Fill PDF online

Rate (4.7 / 5) 72 votes
APPLICATION FOR A SEWAGE TANK PUMPER PERMIT
For Department Use Only
_______________County Health Department
______________ Date Received /Fee Paid
_______________ Co. Health Dept ID No.
______________ Receipt Number (if applicable)
______________ Date Permit Issued
TO BE COMPLETED AND SIGNED BY THE APPLICANT
1.
Name of Business __________________________________________________ Telephone (
) _____________
Street Address _____________________________________________________ Telephone (
) _____________
City ______________________________________________ State ___________ Zip _______________________
Owner/ Proprietor’s Name ___________________________________________ Telephone (
2.
) _____________
Mailing Address _______________________________________________________________________________
City ______________________________________________ State ___________ Zip _______________________
AOWB LICENSING INFORMATION (if applicable)
AOWB Licensee Name _________________________________________________________________________
AOWB License No. ________________________________
Expiration Date _______/_______/________
:
3. Type of Waste to be Hauled
Septage
Sewage
Raw Sewage
(including high-strength)
(Portable/Vault Toilet)
4.
Means of Collecting, Transporting, and Disposing of Sewage __________________________________________
5.
Location of Disposal Points, Method of Sewage Disposal, and Type of Waste to be Disposed
Location
Disposal Method
Type Waste
6.
Vehicle Information
Vehicle Tag Number
State of Registration
Sewage Tank Capacity
Disposal Method(s) – Approvals attached
7.
Yes
No
Application is made pursuant to Alabama Law (Section 22-26-2), Code of Alabama, 1975 Alabama Administrative
Code, Chapter 420-3-1-.34(1)(a)1.
I agree to allow inspection of all sewage tank cleaning equipment, vehicles, implements, containers, or other devices and sites used in the
collection, transportation, or disposal of sewage tank contents. I also agree to mark my vehicles(s) and sewage holding tank and to keep
adequate records and submit them to the local health department personnel in accordance with rules of the State Board of Health. I
understand that permit renewal is required each year no later than December 31.
____________________________________
Type or Print Applicant’s Name
_____________________________
____________________________________
Date
Signature of Applicant
ADPH- CEP-1/Rev. 03-13
APPLICATION FOR A SEWAGE TANK PUMPER PERMIT
For Department Use Only
_______________County Health Department
______________ Date Received /Fee Paid
_______________ Co. Health Dept ID No.
______________ Receipt Number (if applicable)
______________ Date Permit Issued
TO BE COMPLETED AND SIGNED BY THE APPLICANT
1.
Name of Business __________________________________________________ Telephone (
) _____________
Street Address _____________________________________________________ Telephone (
) _____________
City ______________________________________________ State ___________ Zip _______________________
Owner/ Proprietor’s Name ___________________________________________ Telephone (
2.
) _____________
Mailing Address _______________________________________________________________________________
City ______________________________________________ State ___________ Zip _______________________
AOWB LICENSING INFORMATION (if applicable)
AOWB Licensee Name _________________________________________________________________________
AOWB License No. ________________________________
Expiration Date _______/_______/________
:
3. Type of Waste to be Hauled
Septage
Sewage
Raw Sewage
(including high-strength)
(Portable/Vault Toilet)
4.
Means of Collecting, Transporting, and Disposing of Sewage __________________________________________
5.
Location of Disposal Points, Method of Sewage Disposal, and Type of Waste to be Disposed
Location
Disposal Method
Type Waste
6.
Vehicle Information
Vehicle Tag Number
State of Registration
Sewage Tank Capacity
Disposal Method(s) – Approvals attached
7.
Yes
No
Application is made pursuant to Alabama Law (Section 22-26-2), Code of Alabama, 1975 Alabama Administrative
Code, Chapter 420-3-1-.34(1)(a)1.
I agree to allow inspection of all sewage tank cleaning equipment, vehicles, implements, containers, or other devices and sites used in the
collection, transportation, or disposal of sewage tank contents. I also agree to mark my vehicles(s) and sewage holding tank and to keep
adequate records and submit them to the local health department personnel in accordance with rules of the State Board of Health. I
understand that permit renewal is required each year no later than December 31.
____________________________________
Type or Print Applicant’s Name
_____________________________
____________________________________
Date
Signature of Applicant
ADPH- CEP-1/Rev. 03-13