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

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 APPLICATION
OK TO USE SITE INSPECTION
Real Estate Site Inspection Form

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 Inspection Form

WELL PERMIT APPLICATION

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

 

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