2. City of Terrell

   Municipal Development

   201 E. Nash St. | Terrell, TX 75160

4. Type of Permit

6. 1. Commercial

   1. Residential

8. Applicant Information

10. Property Owner
11. DL/ID
13. Mailing Address
15. Phone
16. Email

18. Property Identification

20. Address
21. Parcel ID
23. Legal Description

    Include copy of deed, sales contract, plat, etc.

25. Residential

26. Sq. Ft.
27. # of Bedrooms
    -- Select One --123456
28. # of Bathrooms
    -- Select One --123456
30. Commercial (Including Multi-Family)
31. Sq. Ft.
32. Type
33. # of Employees

35. Installer Information

37. Name
38. Phone
40. OSSF #
41. Business Name and Email

43. The undersigned applicant certifies that all information supplied herein is true and correct to the best of my knowledge and no incorrect information we provided for purposes of obtaining a permit to construct an on-site sewage facility and applicant either owns and/or has authority to construct an on-site sewage facility on this property. Permission is hereby granted to a designated representative of the licensing authority, City of Terrell Municipal Development Department, to enter said property for purposes of inspection, to determine compliance with applicable laws, standards, rules and regulations.

45. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
47. Electronic Signature and Date

49. Please note: all information must be provided, any missing or incomplete information may cause a delay in the approval of the permit.

Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field