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
- 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
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 2019 Level 1 application
- SERVE SAFE 2019 Level 2 application
REGISTRATION FORMS
- Septage Haulers Registration
- Water Haulers Application
- Home Sewage Treatment Service Provider Application
- Application to Install Home Sewage Treatment System
HOUSEHOLD SEWAGE TREATMENT SYSTEMS FORMS
- Permit Process
- Procedure for getting a Site Evaluation
- Site Inspection Form
- Ok to Use Site Inspection Form
- Real Estate Site Inspecion Form
- Variance Request Form
- Guidance Packet
PLUMBING
PRIVATE WATER SYSTEM FORMS
- Chlorination Procedure
- Water Sample Form
- Variance Request Form
- Real Estate Site Inspecion Form
- Well Permit Application
Online Viewing of Private Water Systems Well Logs
** OHIO DEPARTMENT OF NATURAL RESOURCES WATER WELL LOG***
VITAL STATISTICS