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 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 otherwise noted*

 

Records Request Information