Subsurface Wastewater Program
Labels and Forms Order Form

FOR LICENSED SITE EVALUATORS, LICENSED PLUMBERS, AND LOCAL PLUMBING INSPECTORS

Subsurface Wastewater Disposal Applications (HHE-200 Forms), 50 pages per pad.

Your SE license number

Your LPI Certification number

HHE-200 Forms

PAGE 2   $2.50     Number of pads

PAGE 3   $2.50     Number of pads

FOR LOCAL PLUMBING INSPECTORS ONLY

Plumbing Permit Labels

Town/City

Last permit number

FOR MASTER PLUMBERS AND LPI's-INTERNAL PLUMBING APPLICATIONS

    
Internal Plumbing Permit Applications with triplicate carbon for Master Plumbers and Plumbing Firms that do not have a copy machine.

Number requested

Your Master Plumber License number   

or

LPI Certification number

Please bill me if payment is required.     

A check or money order payable to "Treasurer of the State of Maine" has been sent under separate cover to: DEH, 286 Water Street 3rd Floor, Augusta, ME 04333.

First Name:  

Last Name:

Address: 

Town or City   State:  Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah
Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip Code: