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Environmental Health

2509 Crill Ave, Suite 300
Palatka, FL 32177
Phone: (386) 326-7189
Hours: Mon-Fri 8am-4:30pm

The following list contains forms and applications that you may need.

Biomedical Waste & Community Used Sharps Disposal Program

• Application for Biomedical Waste Generator Permit/Exemption DH 4089
• Application for Biomedical Waste Transporter Registration DH 4106
• Application for Biomedical Waste Storage Permit DH 4107
• Application for Biomedical Waste Sarps Collection Program Permit DH 4108
• Application for Biomedical Waste Treatment Permit DH 4111
• Biomedical Waste Training Video: Order Form
• Biomedical Waste Operating Plan

Body Piercing Forms

• Application for Body Piercing Salon License

Food Establishment

• Application for a Sanitation Certificate
• Food Establishment Plan Review Guide

Migrant Labor Housing Permit

• Application for Migrant Labor Camp or Residential Migrant Housing Permit 4082

Mobile Home Parks

• Application for mobile home park, mobile home park housing migrant farmworkers, lodging park, recreational vehicle park and recreational camp Rev 4037

OSTDS Forms

• Application for Onsite Sewage Treatment and Disposal System Construction Permit DH 4015 page 1
• Application for Onsite Sewage Treatment and Disposal System Construction Permit DH 4015 page 2
• Site Evaluation and System Specifications DH 4015 page 3
• Existing System and System Repair Evaluation DH 4015 page 4
• Application for Onsite Sewage Treatment and Disposal System Operating Permit DH 4081
• Application for Variance from Chapter 64E-6, FAC

Pools

• Application for Approval of Swimming Pool Plans DH 914
• Application for Swimming Pool Operating Permit DH 916
• Application for a Public Bathing Place Operating Permit/Authorization DH 917
• Application for Swimming Pool Exempt Status > 32 units DH 1704
• Application for Annual Renewal or Reissuance of Public Swimming Pool/Bathing Place Operating Permit DH 4063
• Application for Swimming Pool Exempt Status 32 units or less DH 4065

Tanning

• Tanning Facilities Application DH 4098
• Tanning Facility Injury Report

Water Programs

Irrigation

• Irrigation Construction Permit Application
• Irrigation/Landscape "As Built" Sketch

Safe Drinking Water Act

• DEP Safe Drinking Water Program Laboratory Reporting Form
• Notice of Lead Sample Results
• Notice of Lead and Copper Sample Results

Well Construction Program

• Application for Limited Use and Private Water System Construction Permit
• Application for Limited Use and Private Water System Operating Permit
• Department of Health Application for Variance from Chapter 64E-8, F.A.C. Drinking Water Systems
• State of Florida Well Completion Report
• State of Florida Permit Application to Construct, Repair, Modify, or Abandon a Well

For more information on our services and fees please call: (386) 326-7189