Applications & Forms

Below are forms and/or applications for a variety of programs offered through the Ashtabula County Health Department.  You may print off any of these forms for your convenience.

We do NOT accept credit cards or out-of-state checks.

Please make checks or money orders payable to the Ashtabula County Health Department.   A return check fee will be charged from the Treasurer’s Office per ORC Section 321.48 for any returned checks.

Ashtabula County Health Department

12 West Jefferson St.

Jefferson,  OH  44047

440-576-6010

If you would like more detailed information on these programs please select the appropriate link in the Environmental Health section.

Animal Bites/Rabies

ANIMAL BITE FORM

DISPOSAL OF CONSTRUCTION AND DEMOLITION DEBRIS (C&DD) RESULTING FROM DEMOLITION OF A STRUCTURE

C&DD APPLICATION

FOOD SERVICE OPERATIONS

Food Service Plan Review

Application for FSO or RFE

TEMPORARY FOOD LICENSE APPLICATION

Vending Machine Application

MOBILE FOOD SERVICE

QUESTIONS & ANSWERS ABOUT MOBILES
APPLICATION FOR MOBILE FOOD LICENSE

 

SERV-SAFE CLASS INFORMATION

SERV SAFE 2018 Level II

 

HAULERS / Septage & Water
2018 Septage Haulers Registration
Water Haulers Application 2018

 

HOUSEHOLD SEWAGE TREATMENT SYSTEMS

Home Sewage Treatment Service Provider Application

Application to  Install Home Sewage Treatment System

Procedure for getting a Site Evaluation

Site Inspection Form
OK TO USE SITE INSPECTION
Real Estate Site Evaluation

VARIANCE REQUEST

Guidance Packet

 

Plumbing
Commercial Plumbing Plan Review
Plumbers Registration 2018

 

Private Water Systems

Chlorination_Procedure
Water Sample Form
Variance Request
Real Estate Site Evaluation

WELL PERMIT APPLICATION

** OHIO DEPARTMENT OF NATURAL RESOURCES WATER WELL LOG***

 

Vital Statistics

Birth Certificate Form
Death Certificate Form 2018
Ohio Department of Health Birth/Death Request Form
Ohio Historical Society Death Certificate Research Request Form