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 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

REGISTRATION FORMS

Apply Weekdays 8:00 a.m.-10:00 a.m.

Apply Weekdays 8:00 a.m.-10:00 a.m.

Home Sewage Treatment Systems 

PLUMBING

Hours for plumbing department

8:00 a.m. to 9:30 a.m. Weekdays

PRIVATE WATER SYSTEM FORMS

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*