Septic-to-Sewer Financial Assistance Program Application

Submit this completed form in order to apply for the Septic-to-Sewer Financial Assistance Program.
EXCLUSIONARY CLAUSE: Individuals who petition for an exception from connecting their septic-to-sewer are ineligible to apply for the Septic-to-Sewer Financial Assistance Program.

Please check one or ALL boxes below to request funding.

WASD Grant
WASD Zero-Interest Loan
WASD Low-Interest Loan

Homeowner/Applicant Information

Last Name

First Name

Address

City

Zip code

Cell phone number

Email Address

Co-Owner/Applicant Information

Last Name

First Name

Address

City

Zip code

Cell phone number

Email Address

Applicant:

Applicant:
	Yes	No
Are you the registered owner of the home?	Yes	No
Does the home have a Homestead Exemption?	Yes	No
Is the home a single-family or duplex unit?	Yes	No
Are your property taxes paid for current and past years?	Yes	No

Co-applicant:

Co-applicant:
	Yes	No
Are you the registered owner of the home?	Yes	No
Does the home have a Homestead Exemption?	Yes	No
Is the home a single-family or duplex unit?	Yes	No
Are your property taxes paid for current and past years?	Yes	No

Do you have an outstanding debt with a Miami-Dade County Department/Agency/Trust?

Provide the following information for that debt.

Name of County Dept./Agency/Trust:

Amount owed: