Environmental Health Applications, Forms & Fees

The following are links to applications, forms and fees for programs associated with Washtenaw County Environmental Health. For questions, please contact (734) 222-3800.

Applications

Food Service:

• Food Service License Application*
• Temporary Food Service License Application
• Food Service Plan Review Application
• Restaurant Change of Owner Application
• STFU Notice of Intent to Serve
• Mobile Food Service Establishment Commissary Verification Form  

Pollution Prevention:

• 2012 Pollution Prevention Status Sheets  [word document]  [pdf document*]

Well/Septic:   

• Application for Residential Onsite Well and/or Sewage Project (well permit, sewage permit, soil evaluation, etc.)  [word document]  [pdf document**]
• Application for Non-Residential Onsite Well and/or Sewage Project  [word document]  [pdf document*]
• Application for Environmental Health Addition/Change of Use Review 
• Application for Subdivisions and Site Condominiums
• Auxiliary Well Registration Form
• Application for Non-Potable Well Project
• Septic Tank Only Installation Affidavit  
• Time of Sale Inspector Application*
• Time of Sale Inspection Report* 
• Time of Sale Escrow Agreement*
• Application for Certification as a Sewage System Installation and Repair Contractor
• Septic Tank Pumper Report  [word document]  [pdf document*]  
• Sewage System Operation & Maintenance Report*

Miscellaneous:

• Temporary Campground License Application
    

Forms

• Credit Card Authorization Form
• Freedom of Information Act (FOIA) Request Form

Fees

• 2012 Environmental Health Fee Schedule - This is a comprehensive listing of fees for all Environmental Health programs and services. For questions about fees, please contact Leon Moore (734-222-3848) or Kristen Schweighoefer (734-222-3968), Supervisors in the Environmental Health Division.
• Temporary Food Establishment Licensing Fees
• Water Testing Fees 

*Please note that this is an Adobe Acrobat "smart form." You can type information into the form, then print it out and mail or fax it to our office. However, you will NOT be able to save an electronic copy of anything you type on the form, so please keep a paper copy of the completed report for your records.