Where to obtain forms
Environmental Public Health Services located at
Clark County Center for Community Health
1601 E. Fourth Plain Blvd., Vancouver WA.
(360) 397-8428
Follow all instructions on the informational packet or on the form.
Signatures must be handwritten.
Form/Description: |
Used By: |
Request for Access to Public Records |
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| Request for Access to Public Records form (pdf format - 36K) | Anyone requesting access to or copies of public records related to environmental public health services |
Food Safety |
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Plan Review Application - Application for health department review of facilities and operational plan for a new or remodeled food service establishment |
Clark County food service industry owners and/or operators |
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Food Service Establishment Plan Review Application for School Portables - Application for health department review of facilities and operational plan for school portable food service operation |
Clark County public and private food service operators |
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Permit Application for a Food Service Establishment - Application for a new or renewed Public Health permit to operate a food service establsihment in Clark County |
Clark County food service industry owners and/or operators |
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Temporary Food Service Establishment Permit - Instructions and application to operate a temporary food service concession at an event in Clark County |
Clark County food service industry concessionaires |
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Memorandum of Agreement for Commisary Usage - Memorandum of Agreement for a licensed food service establishment to provide a caterer or mobile food unit access and use of licensed establishment as a commisary kitchen for preparation and storage of food items and dishwashing |
Licensed Clark County food service establishment owner/operators |
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Food Worker Card Test Registration Form - Registration for food worker testing at Clark County Public Health |
Clark County food service industry workers |
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Public Pools and Spas |
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Pool/Spa Permit Application Form - Health department application for permit to operate a commercial and/or public pool or spa |
Owner/operators of motels, inns, apartments, sports/recreation complexes, etc. |
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Pool Log (PDF - 12K) - Log sheet for recording daily and weekly pool operational conditions such as pH level, temperature, flow rate, alkilinity, disinfection, chemical additives, operational problems |
Owner/operators of motels, inns, apartments, sports/recreation complexes, etc. |
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Spa Log (PDF - 12K) - Log sheet for recording daily and weekly spa operational conditions such as pH level, temperature, flow rate, alkilinity, disinfection, chemical additives, operational problems |
Owner/operators of motels, inns, apartments, sports/recreation complexes, etc. |
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Water Systems |
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Application for Water Evaluation Services - Application for evaluation of individual well, small public water system, irrigation well, or health authority verification for domestic water system |
Developers of real property |
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Water Sample Information for a Nitrate Nitrogen Chemical Analysis - Laboratory testing form for the presence of nitrates in drinking water, and instructions for collecting and submitting the sample for testing |
Users of residential wells or public water systems |
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Water Bacteriological Analysis Form - Laboratory testing form for the presence of harmful bacteria in drinking water, and instructions for collecting and submitting the sample for testing |
Users of residential wells or public water systems |
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Water Facilities Inventory (WFI) - State Department of Health Drinking Water Operations form for collecting statistical information about existing water systems |
Well owners and operators |
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Small Public Water Supply Agreement Letter - Letter of agreement/permission for connecting a specified person to an existing water well and person(s) responsible for maintenance and upkeep; for cooperative sharing of a well with another party or family |
Land developers and property owners |
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Onsite Septic Systems/Water Systems |
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Health Authority Report Application - Application for Public Health certification of sewage disposal and water supply systems on real property; used in real property sale |
Land developers and property owners |
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Water Samples & Health Authority Information Sheet - Grid for applicant to sketch the site features; attaches to Health Authority Report Application |
Land developers and property owners |
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Onsite Septic Systems |
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Onsite Sewage System Permit Application - Application for an onsite sewage system operating permit |
Land developers and property owners |
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Applicant's Checklist for Development Review Applications Proposing Use of Public Sewer - Checklist of supporting materials to be submitted with property owner's application for development review of property proposed for connection to public sewer |
Land developers and property owners |
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Applicant's Checklist for Development Review Applications Proposing Use of Onsite Sewage Treatment System(s) - Checklist of supporting materials to be submitted with property owner's application for development review of property proposed for onsite sewage treatment system |
Land developers and property owners |
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Development Review Application - Application for public health review of proposed property development plan |
Land developers and property owners |
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Onsite Sewage Application Plot Plan for Individual Lot and Sample Sheet - Grid for appliant to draw proposed plot plan; example sheet included |
Land developers and property owners |
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Release Letter Checklist - Checklist of actions and materials needed to obtain Health Department release letter for connection to an onsite sewage system |
Land developers and property owners |
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Release Letter for Connection to Onsite Sewage System - Health Department release letter to connect to an onsite sewage system |
Land developers and property owners |
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Septic System Installer Application for Permit - Application for a permit or renewal of permit to operate as a licensed septic system installer |
Prospective or current septic system installers |
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Onsite Sewage System Request for Waiver from State Regulations - Public Health form and instructions to request a waiver from state septic regulations due to mitigating conditions |
Onsite sewage system owners and operators |
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Reporting Form: Repairs - For septic system owner/operator to report needed system repair(s) |
Onsite sewage system owners and operators |
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Winter Evaluation Fact Sheet & Checklist (High Water Table Evaluations for Onsite Sewage Systems) - Form explaining purpose of winter evaluations with checklists for evaluation application and site preparation |
Land developers and property owners |
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Temporary Hardship Application Checklist - Checklist of actions and materials needed to obtain a temporary hardship permit for two residences to share one septic system on a single lot |
Onsite sewage system owners and operators |
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Temporary Hardship Connection Affidavit - Legal affidavit of temporary hardship connection; must be notarized and filed with Clark County Superior Court Clerk's office |
Onsite sewage system owners and operators |
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Property Declaration Recording of Temporary Occupancy and Use of Existing Home and Onsite Septic System Until New House is Built - Legal declaration to assure that an existing home and septic operating system are legally removed and abandoned when a new home is built; must be notarized and filed with Clark County Superior Court Clerk's office |
Onsite sewage system owners and operators |
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Sewer Availability Request Form - To request determination of availability of sewer district service to individual property |
Onsite sewage system owners and operators |
