Applications, Forms & Fees

Food Service

  1. 2019 Food Service Plan Review Application (PDF)
  2. 2019-2020 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. 2019 P2 Cover Letter (PDF)
  1. 2019 Pollution Prevention Status Sheets (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)
  1. Septic Tank Pumper Report (PDF)
  2. Time of Sale Escrow Agreement (PDF)
  3. Time of Sale Inspection Report (PDF)
  4. Time of Sale Inspector Application (PDF)
  5. 2019 Initial Application for Certification as Sewage System Installation and Repair Contractor (PDF)
  6. 2019 Renewal Application for Certification as Sewage System Installation and Repair Contractor (PDF)
  7. Processing Procedures and Guidelines for Subdivisions and Site Condominiums

Forms

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

Fees

  1. 2019 Environmental Health Fee Schedule (PDF)
  2. 2019 Temporary Food Service Licensing Fees (PDF)
  1. Water Testing 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.