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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 Now Accept Credit Cards!!!  Please Call our Office or you may use your credit card at the window.

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*

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