Forms Available:
~ Most Requested Forms ~  Application to Access Records - FOIL (.pdf)  Tobacco Sale Registration and Permit Application (.pdf)  Wastewater Disposal System Registration and Notice of Intent (SAN-36) (.pdf)     - For homeowners and installers Questions? Get answers using Food Service  Food Establishment Self Inspection Checklist (HD-SAN141) (.pdf)     - For use by food service operators and managers to facilitate compliance with the New York State Sanitary Code, Subpart 14-1.  Temporary Food Service Permit Application (.pdf) Questions? Get answers using General Engineering  Certification of Construction Compliance (HD-159) (.pdf)     - For use by engineers/licensed architects, operators  Engineering Report for Swimming Pool Plans (.pdf)     - For use by engineers/licensed architects, operators  Sewer/Water Adequacy for New/Revised Use (HD-ENH300) (.pdf)     - For use by business owners and operators Questions? Get answers using Health Care Providers  Confidential Case Report (DOH-389) (.pdf)     - For use by Health Care Providers.  Please see the Physician's Guide to Dutchess County Public Health Services Reporting Requirements (.pdf) for further information.  Dutchess County Department of Health Sexually Transmitted Disease Reporting (.pdf)     - For use by Health Care Providers.  Please see the Physician's Guide to Dutchess County Public Health Services Reporting Requirements (.pdf) for further information. Questions? Get answers using Subdivision and Individual Lots  Deep Test Results (HD-185) (.pdf)     - For plan approval documentation by engineers/licensed architects  Extension of Approval, Application for (HD-164) (.pdf)     - For use by owners to request extension of expired or expiring approvals.  Fill Section Certification (HD-5) (.pdf)     - For plan approval documentation by engineers/licensed architects  Low Yield Wells Approval Application (WW-2) (.pdf)     - For use by homeowners  Percolation Test Results (HD-184) (.pdf)     - For plan approval documentation by engineers/licensed architects  Plans for a Wastewater Disposal System, Application for Approval of (HD-1) (.pdf)     - For plan approval documentation by engineers/licensed architects  Residential Sewage Disposal System, Application for Approval of (SAN-34) (.pdf)     - For use by building inspectors  Sample Site Identification and Certification (.pdf)     - For use by owners/operators  Sanitary Facilities for Realty Subdivision, Application for Approval of (.pdf)     - For plan approval documentation by engineers/licensed architects  Waiver Request Form (.pdf)     - For use for waivers from established codes and standards  Wastewater Disposal System Registration and Notice of Intent (SAN-36) (.pdf)     - For homeowners and installers  Water Well, Application to Construct or Abandon (SAN-35) (.pdf)     - For use by well drillers Questions? Get answers using Tobacco  Tobacco Sale Registration and Permit Application (.pdf) Questions? Get answers using Training Courses  Application for Water or Pool Operator Course (.pdf)     - For use by prospective operators Questions? Get answers using Water Supply  Approval of <5 GPM Well, Application for (WW-2) (.pdf)     - For use by owners  Certificate of Waiver from Asbestos Sampling Requirement, Application for (.pdf)  Certificate of Waiver from Disinfection Requirement, Application for (.pdf)     - For use by owners and operators  Water System Operation Report for Ultra-Violet Disinfection Systems Only (.pdf) Questions? Get answers using Miscellaneous  Application to Access Records - FOIL (.pdf)  Data Request Form (.pdf) - Electronic Submission     - Use the above version to complete the form online and submit it electronically.   You must have Adobe Acrobat Standard or Adobe Acrobat Professional installed on your computer to use this version of the form.  Data Request Form (.pdf)     - Use the above version to complete the form online then print it and fax it to the Dutchess County Department of Health at (845) 486-3561.  This version can be completed using Adobe Reader only.  Department of Health Website Satisfaction Survey Questions? Get answers using