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Northeast Tri County Health District, WA

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Land Development Application

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Steps

1. Step One This section is complete This section is incomplete
2. Applicant Information This section is complete This section is incomplete
3. Property Information This section is complete This section is incomplete
4. Directions to Site This section is complete This section is incomplete
5. General Information This section is complete This section is incomplete

Step One

Supporting Materials
Items to Include with Application and Site Map Information (PDF)
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Applicant Information

Name
Mailing Address
City
State
Zip Code
Phone
Email
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Property Information

Property Owner Name
Legal Description
A copy of the most recent tax statement, a printout from the County Assessor Office, or a recorded document that verifies ownership of the parcel must be provided with this application.
Rural Description or Subdivision Name, Lot & Block Number
Section
Township
Range
Parcel Number
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Directions to Site

Provide an accurate map or directions to the site. Mileage from a significant road intersection, landmark or flagging the entrance to the plat is very useful to locate undeveloped property.
Map or Directions Upload
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General Information

The following information applicable to the land development project must be provided before a site review can be scheduled. Please be sure all information is accurate and complete.
1. Site Map
An accurate site map will be required. See the site map minimum information instructions on the attached sheet for the minimum information needed to review the proposed land development.
Upload Site Map
2. Number of Lots
Number of lots to be created
(Show acreage of each lot on site map.)
3. Lot Use
Indicate the proposed use for each of the lots. If there will be a combination of uses, show which lots will be used for each classification on the site map.
1. Singe Family Residential
2. Multi-Family Residential
3. Commercial
4. Other
If other:
Water Supply
Indicate the type of water supply proposed for each lot. If well(s) are existing on any of the proposed lots, show the location on the site map. If community water supply is proposed, provide the water system name and/or ID number.
1. Individual Well
2. Shared Well (2 Connection Water System)
3. Group A Community Water Supply
4. Group B Community Water Supply
ID Number or Name
ID Number or Name
5. Sewage
Indicate what type of sewage system is proposed for this development. If existing on-site sewage systems are located within the proposed project, list the permit number and date of installation on the site map.
1. Individual On-Site Sewage System
2. Connection to an Existing Public or Community Sewage System
3. Develop a New Community Sewage System to Serve All Proposed Lots
Are test holes dug and ready for inspection?
1. Yes
2. No
Are any existing dwellings currently served by an existing on-site sewage system?
1. Yes
2. No
Name & ID Number
6. Other
Please provide the following information if available.
Surveyor Name
Phone
7. Subdivision Application
Subdivision Application must be submitted to the Planning Department at the county prior to submitting this application to Northeast Tri County Health District.
Subdivision Application Submitted?
1. Yes
2. No
Date Submitted:
Project Name or Number
Upload Additional Documents
Example: surveyor maps, tax statement, owner verification.

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Email address

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240 E Dominion Ave
Colville, WA 99114
Phone: 509-684-2262
Fax: 509-684-1002

Ferry County

147 N Clark Suite 1
PO Box 584
Republic, WA 99166
Phone: 509-775-3111

Pend Oreille County

605 Highway 20
Newport, WA 99156
Phone: 509-447-3131

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