Required fields are marked with asterisks (*)

Septic Inspection Release of Information

This form can be used to provide permission from property owners if it is not the owner booking a septic inspection.

Property Owner Name

Property Address

Authorize the Township of Huron-Kinloss and their agents, to release information collected during the septic system inspection of our property to:

Potential buyer Name

This information may also be given to:

Real Estate Agent

Real Estate Agency

Contact Phone Number

Email Address

We understand that the information provided does not constitute any guarantee of the operational fitness or condition of the system, but is only a complication of known information and observations obtained on the date of last inspection through a non-invasive inspection process.

Owner Name

Date

Owner Signature

Clear

Co-Owner Name

Co-Owner Signature

Clear

Send report by

Fax

Mail

In accordance with the Municipal Freedom of Information and Privacy Act, personal information is collected under the authority of the Municipal Act, 2001 and will only be used for the purpose of releasing information collected through the community septic inspection program. Questions about the collection of the personal information may be addressed to the Clerk at the Township of HuronKinloss, 21 Queen Street, P.O. Box 130, Ripley, ON, N0G 2R0 or (519) 395 3735