
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 do not send cash in the mail
Do send a Bank Check or Money Order
Please make bank 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
- PHONE 440-576-6010
- FAX 440-576-5527
If you would like more detailed information on these programs please select the appropriate link in the Environmental Health section.
ANIMAL BITE FORM
CONSTRUCTION AND DEMOLITION AND DEBRIS APPLICATION
- Apply Weekdays 8:00 a.m.-10:00 a.m
FOOD SERVICE FORMS
- Food Service Plan Review
- Application for Food Service Operation Or Retail Food Service Operation
- Temporary Food License Application
- Vending Machine Operation Application
- Questions and Answers about Mobiles
- Application for Mobile Food License
- SERVE SAFE 2020 Level 2 application
REGISTRATION FORMS
Apply Weekdays 8:00 a.m.-10:00 a.m.
- Septage Haulers Registration
- Water Haulers Application
- Home Sewage Treatment Service Provider Application
- Application to Install Home Sewage Treatment System
Apply Weekdays 8:00 a.m.-10:00 a.m.
Home Sewage Treatment Systems
- Permit Process
- Procedure for getting a Site Evaluation
- Site Inspection Form
- Home Sewage Treatment System Abandonment Form
- Ok to Use Site Inspection Form
- Real Estate Site Inspecion Form
- Variance Request Form
- Guidance Packet
PLUMBING
Hours for plumbing department
8:00 a.m. to 9:30 a.m. Weekdays
PRIVATE WATER SYSTEM FORMS
- Chlorination Procedure
- Water Sample Form
- Variance Request Form
- Real Estate Site Inspection Form
- Well Permit Application
Online Viewing of Private Water Systems Well Logs
Click the link below to view water well logs
** OHIO DEPARTMENT OF NATURAL RESOURCES WATER WELL LOG***
VITAL STATISTICS
The hours of operation for ALL Vital Statistics requests
*8:00 a.m. to 4:00 p.m. Weekdays unless other wise noted*