Environmental Health Programs - Forms

All the forms on this site can be filled out using the Adobe Acrobat Reader Software. If you need to obtain the free Adobe Reader please follow this link http://get.adobe.com/reader/

Biomedical Waste & Community Used Sharps Disposal Program

• Application for Biomedical Waste Generator Permit/Exemption DH 4089 (99 kb PDF)
• Application for Biomedical Waste Transporter Registration DH 4106 (140 kb PDF)
• Application for Biomedical Waste Storage Permit DH 4107 (98 kb PDF)
• Application for Biomedical Waste Sharps Collection Program Permit DH 4108 (97 kb PDF)
• Application for Biomedical Waste Treatment Permit DH 4111 (209 kb PDF)
• Biomedical Waste Training Video: Order Form (25 kb PDF)
• Biomedical Waste Operating Plan (70 kb PDF)

Body Piercing Forms

• Application for Body Piercing Salon License (123 kb PDF)
• Body Piercing Salon Injury Report (76 kb PDF)

Food Establishment

• Application for a Sanitation Certificate (31 kb PDF)
• Food Establishment Plan Review Guide (88 kb PDF)

Migrant Labor Housing Permit

• Application for Migrant Labor Camp or Residential Migrant Housing Permit 4082 (202 kb PDF)

Mobile Home Parks

• Application for mobile home park, mobile home park housing migrant farmworkers, lodging park, recreational vehicle park and recreational camp Rev 4037 (27 kb PDF)

OSTDS Forms

• Application for Onsite Sewage Treatment and Disposal System Construction Permit DH 4015 page 1 (82 kb PDF)
• Application for Onsite Sewage Treatment and Disposal System Construction Permit DH 4015 page 2 - Site Plan (34 kb PDF)
• Site Evaluation and System Specifications DH 4015 page 3 (44 kb PDF)
• Existing System and System Repair Evaluation DH 4015 page 4 (97 kb PDF)
• Application for Onsite Sewage Treatment and Disposal System Operating Permit DH4081(78 kb PDF)
• Application for Variance from Chapter 64E-6, FAC (79 kb PDF)
• Credit Card Authorization form (56 kb PDF)

Pools

• Application for Approval of Swimming Pool Plans DH 914 (90 kb PDF)
• Application for Swimming Pool Operating Permit DH 916 (154 kb PDF)
• Application for a Public Bathing Place Operating Permit/Authorization DH 917 (102 kb PDF)
• Application for Swimming Pool Exempt Status > 32 units DH 1704 (72 kb PDF)
• Application for Annual Renewal or Reissuance of Public Swimming Pool/Bathing Place Operating Permit DH 4063 (56 kb PDF)
• Application for Swimming Pool Exempt Status 32 units or less DH 4065 (95 kb PDF)

Residential Care & School Facilities

• Group Care Plan Review Application (43 kb PDF)

Tanning

• Tanning Facilities Application DH 4098 (135 kb PDF)
• Tanning Facility Injury Report (53 kb PDF)

Water Programs

Irrigation

• Irrigation Construction Permit Application (108 kb PDF)
• Irrigation/Landscape "As-Built" Sketch (22 kb PDF)
• Contractor/Owner Irrigation Self Certification Checklist (143 kb PDF)

EH Lab

• New Well Drinking Water Bacteriological Analysis Report Form (112 kb PDF)
• Chemical Water Analysis Report for Non-Regulated Water Systems (66 kb PDF)
• Chemical Water Analysis Report for Private Water Systems (53 kb PDF)

Safe Drinking Water Act

• DEP Drinking Water Microbial Sample Collection Reporting Format (274 kb PDF)
• DEP Safe Drinking Water Program Laboratory Reporting Form (174 kb PDF)
• Notice of Lead Sample Results (99 kb PDF)
• Notice of Lead and Copper Sample Results (74 kb PDF)

Safe Drinking Water Act Documents in Word Format

Notice of Lead Sample Results (40 kb Word document)

Notice of Lead and Copper Sample Results (47 kb Word document)

Well Construction Program

• Application for Limited Use and Private Water System Construction Permit (38 kb PDF)
• Application for Limited Use and Private Water System Operating Permit (43 kb PDF)
• Department of Health Application for Variance from Chapter 64E-8, F.A.C. Drinking Water Systems (67 kb PDF)
• Irrigation/Well Permit Agent Authorization Form (198 kb PDF)
• State of Florida Well Completion Report (307 kb PDF)
• State of Florida Permit Application to Construct, Repair, Modify, or Abandon a Well (220 kb PDF)
• Volusia County Health Department Wells, Pumping Facilities and Irrigation Systems Variance Petition (202 kb PDF)