Mineral County Health Department-Environmental Forms

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The online forms will not save your information. you must type in responses and print the document before closing. Mail document to address on the contact page or walk in and deliver form to us.

Animal Encounter

SG-58

Animal Encounter Report Online Form (Complete Form, Print, and Deliver to us!)

Body Piercing/ Tattoo Studio

	SG-49		General Sanitation Permit Application (Complete Form, Print, and Deliver to us!)
	SG-86		Piercing Studio Plan Review
	SG-88		Piercing Technician Certification Application
	SG-89		Information & Notification
	SG-90		Hepatitis B Declination
	64-80A		Body Piercing Studio Rule Public Notice

Child Care Centers

	SG-49		General Sanitation Permit Application (Complete Form, Print, and Deliver to us!)
	SG-99		Plan Review Information for Child Care Centers (New or Remodeled)

Complaint

SG-51

Online Complaint Form (Complete Form, Print, and Deliver to us!)

Environmental Site Evaluation

MCEF-100

Application For Environmental Site Evaluation

Food Sanitation

	SF-4		Temporary Food Service Guidelines
	SF-5		Food Establishment Permit Application
	SF-7A		Food Guide
	SF -7B		Equipment Guide
	SF-7C		Management Guide
	SF-7D		Employee Guide
	SF-7E		Inspection Guide
	SF-35		Plan Review for New or Remodeled Food Establishments
	1999		Food Code Plan Review References
	Form 1-A		Applicant Food Employee Interview
	Form 1-B		Food Employee Reporting Agreement
	Form 1-C		Applicant and Food Employee Medical Referral
	OLS		Request Food Filth Lab Analysis
	PHSD		Retail Food Emergency Flip Chart

General Sanitation

SG-49

General Sanitation Permit Application (Complete Form, Print, and Deliver to us!)

Mobile Home Park

	SG-49		General Sanitation Permit Application (Complete Form, Print, and Deliver to us!)
	EG-1		Mobile Home Park Specification and Plan Review Summary Form
	EG-2		Application for a permit to Construct, Install, Alter, or Extend a Mobile Home Park
	EG-4		Sewage System Data Sheet
	EG-5		Water System Designs

Recreational Water Facility

	SG-49		General Sanitation Permit Application (Complete Form, Print, and Deliver to us!)
	ER-32		Recreational Water Facility Weekly Report
	SR-153		Recreation Water Facilities Tables

Sewage

	SS-182	Application for a Permit to Construct, Modify, or Abandon a Water Well and/or Install or Modify a Small Sewage Disposal System
	SS-182A	Application to Install or Modify a Small Sewage Disposal System
	MCEF-200	Application for Individual On-site Sewage Evaluation
	ES-57	Affidavit

Home Aeration Unit (HAU) Forms:
	HAU	HAU Application Package
	SS-188	Sewage System with Discharge Permit Application
	SS-188A	Surface Discharge Site Evaluation Report
	SS-191	Annual Report For 600 GPD Point Source Discharge System

Subdivision Forms:
	ES-76	Subdivision Application

Home Loan Evaluation Forms:
	SG-55	Home Loan Evaluation Report
	SG-55A	Home Loan Evaluation Procedures

Septic Tank Cleaner Forms:
	SS-181	Application For Sewage Tank Cleaning Permit

For Installers Only:
	SS-192	Installer Certification Renewal Application

Water

	SW-253	Water Analysis Request (Complete Form, Print, and Deliver to us!)
	SW-253a	Dug Wells (Prior to 2008)
	SW-253b	Approved Pitless Well Installation (Prior to 2008)
	SW-253c	Springs
	SW-253d	Cisterns
	SW-253e	Installing a Pump
	SW-253f	Approved Well House Installation (Prior to 2008)
	SW-253g	Pitless Units
	SW-256	Water Well Application
	SW-258	Water Well Completion Report
	SW-260	Water Well Variance Request
	SW-261	Water Well Abandonment Report
	SW-262	Water Well Pump Installation Report
	DW-22	Water Well Violation Report
	2008	Water Quality Labs
		Private Water Well Owners–What to Do Before Drilling the Well
		Private Water Well Owners–Water Well Pumping Systems
		Private Well Owners-Four Steps to Water Well Safety
		How to Disinfect a Private Water Well

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This page was last updated on 08/12/2008