Applications, Forms & Fees

The Environmental Health office at 705 North Zeeb Road, Ann Arbor is closed for walk-in service.  

Please email [email protected] or call 734-222-3800 for assistance.

Food Service

  1. 2021 Restaurant Plan Review Application (PDF)
  2. 2021-22 Food Service License Application (PDF)
  3. Mobile Food Service Establishment Commissary Verification Form (PDF)
  4. Restaurant Change of Owner/Change of Use Application (PDF)
  1. Special Transitory Food Unit (STFU) and Mobile Food Establishment Plan Review Application (PDF)
  2. STFU Notice of Intent to Serve (PDF)
  3. Temporary Food Service License Application (PDF)
  4. Food Service Variance Application (PDF)

Pollution Prevention

  1. 2021 Pollution Prevention Status Sheet Packet (PDF)
  1. 2021 Pollution Prevention Program Cover Letter (PDF)

Well / Septic

  1. Residential Well and Septic Application (PDF)
  2. Application for Environmental Health Addition or Change of Use Review (PDF)
  3. Application for Subdivisions and Site Condominiums (PDF)
  4. Application for Non-Potable Well Project (PDF)
  5. Auxiliary Well Registration Form (PDF)
  6. Application for Non-Residential Onsite Well and - or Sewage Project (DOC)
  7. Application for Non-Residential Onsite Well and - or Sewage Project (PDF)
  8. Septic Tank Pumper Report (PDF)
  1. Time of Sale Escrow Agreement (PDF)
  2. Time of Sale Inspection Report (PDF)
  3. Time of Sale Inspector Application (PDF)
  4. Processing Procedures and Guidelines for Subdivisions and Site Condominiums (PDF)
  5. 2021 Certified Sewage Contractor Application - RENEWAL (PDF)
  6. 2021 Certified Sewage Contractor Application - INITIAL (PDF)
  7. 2021 COMP Application - INITIAL (PDF)
  8. 2021 COMP Application - RENEWAL (PDF)

Forms

  1. Hearing Request Form (PDF)
  1. Credit Card Authorization Form (PDF)

Fees

  1. Water Testing Fees (PDF)
  2. 2021 Environmental Health Fee Schedule (PDF)
  1. 2021 Temp Food Fees (PDF)

The Credit Card Authorization form (PDF) can be faxed (734-222-3930) or mailed it to our office. For security and privacy reasons, Washtenaw County does not accept credit card information via email.