Request For Information Form - Carroll County Health Department
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1Records Search Request
Date______________________
HEALTH DEPT USE ONLY
Property Identification: Please supply as
Environmental Health Bureau
much information as possible. (Subdivision
Reference No. ___________
290 S. Center Street
Name, Lot No., Tax Map, Grid, and Parcel
Westminster, Maryland 21157
numbers can be found on
your Tax
Phone: 410-876-1884
Date Completed __________
Assessment Notice.)
Any
identifying
Fax:
410-876-4430
information that you can provide would be
helpful
(ex:
public
record
notice).
Incomplete property identification may result in incomplete or incorrect information, or longer search times.
Searches will be conducted as quickly as time permits.
Owner’s Name: ___________________________________________________________________
Street Address: ___________________________________________________________________
Subdivision Name: _________________________ Section No._____________ Lot No._________
Tax Map: ___________ Grid: __________ Parcel: _____________
Year House Built: ______________________ Owner when built: ____________________________
Building Permit Number ___________________________ County File No: ___________________
Well Tag Number: ___________________________ (tag should be attached to well casing)
Note: For some older residences, there may be a metal tag with the file number located near the main sewer
line into the house or attached under the kitchen sink. This number will be helpful in locating Health
Department records. Our office will not have any record of wells or septics installed before 1955, unless an
upgrade or repair was made.
Information Requested:
____ Well Location
______ Septic Location
_____ Perc Results
______ Septic System
____ Well Yield/Depth
______ Preliminary Plat showing well and septic locations
____ Other (specify): ______________________________________________________________
Information requested by:
Name:
___________________________________________
Address:
___________________________________________
___________________________________________
Email: _____________________________
Phone: ___________________________________ Fax: ________________________________
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