Applications and Forms
The following links are provided for your convenience. Feel free to contact us with any questions you may have.
Animal Encounters
For Healthcare Provider/Facility
Body Piercing/Tattoo Studios
SG-49 Application for Permit to OperateSG-86 - Plan Review Information Report (for new or remodeled studios)SG-88 Piercing Technician Certification ApplicationSG-89 - Client Information and Notification Form (Sample)SG-90 - Hepatitis B Vaccination Declination Statement68-80A - Public Notice: Body Piercing Disclosure Statement
Food Sanitation
SF-4: Guidelines for Operating a Temporary Food Service Concession (booklet layout)SF-5: Application for Permit to Operate a Food Service EstablishmentSF-5B Application for Permit to Operate a Temporary Food Service EstablishmentSF-7E: Inspection Guide - 2013 Food CodeSF-35: Plan Review Information Report for Food Service Establishments (new or remodeled)SF-35 Addendum: Information PacketForm 1-A: Applicant and Food Employee InterviewForm 1-B: Food Employee Reporting AgreementForm 1-C: Applicant and Food Employee Medical ReferralRetail Food Establishment Emergency Flip Chart
Food Sanitation - Mobile Food Establishments
HB 5017 - Establishes a Statewide Mobile Food Establishment
General Sanitation
Septic Tank Cleaner Forms:
Subdivision Forms:
Water
SW-252c SpringsSW-252d CisternsSW-252e Installing a Hand PumpSW-252g Pit-less UnitsSW-253: Request for Water AnalysisSW-256 Water Well ApplicationSW-258 Water Well Completion ReportExplanation and Guide to Completing The SW-258SW-259: Water Well Violation ReportSW-260: Water Well Variance Request FormSW-261: Water Well Abandonment ReportSW-262: Water Well Pump Installation ReportExplanation and Guide To Completing The SW-262
Hampshire County Health Department
16189 Northwestern Turnpike, Augusta, West Virginia 26704, United States
