Applications & Forms

Bank Checks or Money Orders Accepted
Make bank checks or money orders payable to the Ashtabula County Health Department. A fee will be charged for any returned checks. Applications/permits are not refundable.
Do not send cash in the mail. 

Ashtabula County Health Department

12 West Jefferson St.

Jefferson, OH  44047

  • PHONE          440-576-6010
  • FAX                 440-576-0085 or 440-576-5527

If you would like more detailed information on these programs, please select the appropriate link in the Environmental Health menu.

Applications can be submitted in-person on weekdays between 8am and 10am. 

ANIMAL BITE FORM

CONSTRUCTION AND DEMOLITION AND DEBRIS APPLICATION

FOOD SERVICE FORMS

    HOME SEWAGE TREATMENT SYSTEMS

    PLUMBING

    PRIVATE WATER SYSTEM FORMS

    REGISTRATION FORMS

    VARIANCES

    • Variance Request Form