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2. Type of License*

   Please select if you are submitting for a new/reinstate expired license or are renewing an already active license.

   1. New License or Reinstate Expired - $100

   1. Renew Existing/Active License - $50
4. Name of Company*
   Please provide the name of the company that will be represented on the license.
6. Mailing Address*
   Mailing Address for Company
8. Phone Number *
   Phone Number for Company
9. E-mail Address*
   Email Address for Company
11. Name of Applicant*
    Please include the name of the individual applying for the license.
13. Have you taken and passed the "Part A Installer Exam" in another County?*
    -- Select One --YesNoI don't know

    Clear Creek County is part of the "Part A Installer Exam" group. If you have taken this exam and passed in another County you may be exempt from testing in Clear Creek County.
14. Name of other County
    If you answered "Yes" to the previous question, please provide the name of the County you tested in.
16. Do you currently hold the NAWT Installer Certification?*
    -- Select One --YesNo
17. Would you like to be added to our public list of Licensed OWTS Installers?*
    -- Select One --YesNo

    If you pass the exam, you have the option to be placed on a list of licensed installers that is distributed publicly. Your business name, email and phone number will be included on the list.
19. 
21. *Disclaimer*
    By submitting this form you hereby certify that if you applying for a license to perform work on and install onsite wastewater treatment systems (OWTS) in Clear Creek County. You hereby agree to conduct all OWTS work in accordance with the Clear Creek County OWTS Regulations. You understand that if a license is issued that your license may be revoked if reason presents itself per the Clear Creek County OWTS Regulation. You understand that a license is active from one calendar year from the date of issue and that you may reapply for your license prior to expiration for a decreased fee and will not be required to retake the exam, unless there is a regulatory change stating otherwise. You must obtain a minimum passing grade of 75% to receive a license.
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

* indicates a required field