Environmental Services

Applications and Forms

All Applications and Forms are in PDF format and require that your computer be running Adobe® Acrobat Reader software.  

Please Note: If you experience difficulty in downloading or printing forms, please refer to the Adobe Web Site for troubleshooting and support guidelines. 

If you have any questions or concerns, please contact us for further assistance. 

Animal Encounter: 

SG-58 Animal Encounter Report Form

• For Healthcare Provider/Facility Attending to Animal Bite Patient

Body Piercing/Tattoo Studios: 

SG-49 Application for Permit to Operate 

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 Application for Permit to Operate 

SG-99 Plan Review Information for Child Care Centers (New or Remodeled) 

Complaint:

SG-51 Complaint Form 

Food Sanitation:

SF-4: Guidelines for Operating a Temporary Food Service

SF-5 Food Establishment Permit Application

SF-5B Application for Permit to Operate a Temporary Food Service Establishment 

SF-7E Inspection Guide - 2013 FDA Food Code

SF-35 Plan Review for New or Remodeled Food Establishments

Form 1-A Applicant Food Employee Interview 

Form 1-B Food Employee Reporting Agreement 

Form 1-C Applicant and Food Employee Medical Referral 

PHSD Retail Food Emergency Flip Chart 

General Sanitation: 

SG-49 Application for Permit to Operate 

Manufactured Home Community: 

SG-49 Application for Permit to Operate 

EG-1 Manufactured Home Community Specification and Plan Review Summary Form

EG-2 Application for a permit to Construct, Install, Alter, or Extend a Manufactured Home Community

EG-4 Sewage System Information and Design Data Sheet 

EG-5 Water System Design Information and Data Sheet 

Recreational Water Facilities: 

SG-49 Application for Permit to Operate 

ER-32 Recreational Water Facility Weekly Report

SR-153 Recreation Water Facilities Tables 

Sewage: 

SS-182A Application to Install or Modify a Small Sewage Disposal System

ES-57 Affidavit 

    Subdivision Forms:  

    ES-76 Subdivision Application 

    Septic Tank Cleaner Forms:  

    SS-181 Application For Sewage Tank Cleaning

    For Installers Only: 

    SS-192 Installer Certification Renewal Application 

Water: 

SW-252c Springs 

SW-252d Cisterns 

SW-252e Installing a Hand Pump 

SW-252g Pit-less Units 

SW-253 Request for Water Analysis 

SW-256 Water Well Application 

SW-258 Water Well Completion Report  

• Explanation and Guide to Completing The Water Well Completion Report (SW-258)

SW-259: Water Well Violation Report 

SW-260 Water Well Variance Request 

SW-261 Water Well Abandonment Report 

SW-262 Water Well Pump Installation Report 

• Explanation and Guide To Completing The Pump Installation Report (SW-262) 

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​

Listing of West Virginia Certified Drinking Water Laboratories

or

Contact Department of Agriculture Moorefield, WV (304) 538-2397