{"id":1777,"date":"2022-07-11T14:07:25","date_gmt":"2022-07-11T14:07:25","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/chesterfield\/?page_id=1777"},"modified":"2026-04-10T17:24:42","modified_gmt":"2026-04-10T17:24:42","slug":"forms-applications-chesterfield","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/chesterfield\/environmental-health\/forms-applications-chesterfield\/","title":{"rendered":"Forms & Applications"},"content":{"rendered":"
\n
\n\t\n\n\n\n\n\n\n\n\n\n\n\n
Food Service Applications, Forms, & Regulations<\/caption>\n
Name:<\/b><\/th>\nDescription:<\/b><\/th>\n<\/tr>\n
Foodservice Permit Application<\/a><\/strong><\/td>\nApplication for a Virginia Department of Health Foodservice Establishment Permit<\/td>\n<\/tr>\n
Plan Review Application<\/strong><\/a><\/td>\nApplication for Virginia Department of Health Plan Review<\/td>\n<\/tr>\n
Plan Review Checklist\/Comprehensive Guide<\/a><\/strong><\/td>\nPlans to review for approval before Food Establishment Permit<\/td>\n<\/tr>\n
VA Food Regulations<\/strong><\/a><\/td>\nVirginia Department of Health Food Regulations<\/td>\n<\/tr>\n
VDH Recognized Food Protection Manager Certifications<\/a><\/strong><\/td>\nList of Virginia Department of Health recognized Food Protection Manager Certification opportunities<\/td>\n<\/tr>\n
Food Safety<\/a><\/strong><\/td>\nList of Food Safety resources and information<\/td>\n<\/tr>\n
Mobile Unit Checklist<\/a><\/strong><\/td>\nVirginia Department of Health required Mobile Unit conditions Checklist<\/td>\n<\/tr>\n
Temporary Food Establishment Application<\/a><\/strong><\/p>\n

*These forms can be emailed to chesterfield_eh@vdh.virginia.gov<\/a>.
\nOnce the application has been submitted, please call (804)-748-1691<\/strong>\u00a0to pay the $40 fee (effective July 1, 2011) using Visa or Master card. Payments may also be received by mail or in person at<\/p>\n

9501 Lucy Corr Circle
\n<\/strong>Chesterfield, VA 23832<\/strong><\/p>\n<\/td>\n

Application for a Temporary Food Establishment which must be submitted 10<\/strong> business days prior to an event<\/td>\n<\/tr>\n
TFE Checklist<\/a><\/strong><\/td>\nChecklist of requirements for a Temporary Food Establishment<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n
Fees effective as of July 1, 2011<\/b><\/caption>\n
Program<\/strong><\/th>\nPlan Review Fee<\/strong><\/th>\nAnnual Permit Fee<\/strong><\/th>\n<\/tr>\n
Hotels\/Motels<\/td>\n$40<\/td>\n$40<\/td>\n<\/tr>\n
Restaurants<\/td>\n$40<\/td>\n$40<\/td>\n<\/tr>\n
Summer Camps<\/td>\n$40<\/td>\n$40<\/td>\n<\/tr>\n
Campgrounds<\/td>\n$40<\/td>\n$40<\/td>\n<\/tr>\n
Temporary Food Permit<\/td>\nn\/a<\/td>\n$40 Annual Permit Fee<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
Hotel, Summer Camp, Campground, & Migrant Labor Camp Applications, Forms, & Regulations<\/b><\/caption>\n
Name:<\/b><\/th>\nDescription:<\/b><\/th>\n<\/tr>\n
Hotel Permit Application<\/a><\/strong><\/td>\nApplication for a Virginia Department of Health Hotel<\/td>\n<\/tr>\n
Hotel Plan Review Application<\/a><\/strong><\/td>\nApplication for a Hotel Plan Review<\/td>\n<\/tr>\n
Sanitary Regulations for Hotels<\/a><\/strong><\/td>\nVirginia Department of Health Sanitary Regulations for Hotels<\/td>\n<\/tr>\n
Chapter 460. Regulations Governing Tourist Establishment Swimming Pools and Other Public Pools<\/a><\/strong><\/td>\nVirginia Department of Health Regulations for Tourist Establishment Swimming Pools<\/td>\n<\/tr>\n
Chapter 462. Swimming Pool Regulations Governing the Posting of Water Quality Test Results<\/strong><\/a><\/td>\nVirginia Department of Health Regulations for Posting Water Quality Test Results<\/td>\n<\/tr>\n
Campground Application<\/a><\/strong><\/p>\n

Application for a Campground Plan Review<\/a><\/strong><\/p>\n<\/td>\n

Applications for a Virginia Department of Health Campground Permit & Plan Review<\/td>\n<\/tr>\n
Summer Camp Application<\/a><\/strong><\/td>\nApplication for a Department of Health Summer Camp Permit<\/td>\n<\/tr>\n
Migrant Labor Camp Permit Application<\/a><\/strong><\/td>\nApplication for a Migrant Labor Camp Permit<\/td>\n<\/tr>\n
Chapter 501. Rules & Regulations Governing the Construction & Maintenance of Migrant Labor Camps<\/b><\/a><\/strong><\/td>\nVirginia's Legislative Informative System, Chapter 501. Rules & Regulations Governing the Construction & Maintenance of Migrant Labor<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
Onsite Sewage (Septic) & Well Water Program<\/strong><\/caption>\n
Name:<\/b><\/th>\nDescription:<\/b><\/th>\n<\/tr>\n
Commonwealth of VA Septic & Well Application<\/a><\/strong><\/td>\nApplication for Sewage System & Water Supply<\/td>\n<\/tr>\n
SAP Application<\/a><\/strong><\/td>\nSafe, Adequate, & Proper (SAP) Application<\/td>\n<\/tr>\n
Survey Plot Waiver<\/a><\/strong><\/td>\nRequest for a Waiver to the Survey Requirement<\/td>\n<\/tr>\n
Verification of System Location<\/a><\/strong><\/td>\nDocumentation Verifying Sewage System Location<\/td>\n<\/tr>\n
Temporary Pump & Haul<\/a><\/strong><\/td>\nApplication for Pump & Haul<\/td>\n<\/tr>\n
Sewage Handler<\/a><\/strong><\/td>\nApplication for Sewage Handling Permit<\/td>\n<\/tr>\n
Find an Operator, OSE<\/a><\/strong><\/td>\nVDH Septic System & Private Well Service Providers<\/td>\n<\/tr>\n
VDH Water Services<\/a><\/strong><\/td>\nVDH Description of On-Site Water & Wastewater Services<\/td>\n<\/tr>\n
Regulations & Current Regulatory Activity<\/a><\/strong><\/td>\nVDH Regulations & Current Regulatory Activity<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
APPLICATION TYPE<\/strong><\/th>\nFEE (effective June 27, 2025)<\/strong><\/th>\n<\/tr>\n
Certification letter with OSE\/PE documentation, < = 1,000 gpd<\/a><\/strong><\/td>\n$320<\/td>\n<\/tr>\n
Certification letter with OSE\/PE documentation, > = 1,000 gpd<\/a><\/strong><\/td>\n\u00a0$1,400<\/td>\n<\/tr>\n
Construction permit for only onsite sewage system with OSE\/PE documentation, < = 1,000 gpd<\/a><\/strong><\/td>\n$225<\/td>\n<\/tr>\n
Construction permit for only onsite sewage system with OSE\/PE documentation, > = 1,000 gpd<\/a><\/strong><\/td>\n$1,400<\/td>\n<\/tr>\n
Private well only, with or without OSE\/PE documentation<\/a><\/strong><\/td>\n$300<\/td>\n<\/tr>\n
Repair permit for a treatment works, < 1,000 gpd with OSE\/PE documentation<\/a><\/strong><\/td>\n$225<\/td>\n<\/tr>\n
Repair permit for a treatment works, > 1,000 gpd with OSE\/PE documentation<\/a><\/strong><\/td>\n$1,400<\/td>\n<\/tr>\n
Voluntary Upgrade for a treatment works, < 1,000 gpd with OSE\/PE documentation<\/a><\/strong><\/td>\n$225<\/td>\n<\/tr>\n
Voluntary Upgrade for a treatment works, > 1,000 gpd with OSE\/PE documentation<\/a><\/strong><\/td>\n$1,400<\/td>\n<\/tr>\n
Safe, adequate, and proper evaluation with OSE\/PE\/Installer\/Operator Documentation<\/a><\/strong><\/td>\n$100<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"

Food Service Applications, Forms, & Regulations Name: Description: Foodservice Permit Application Application for a Virginia Department of Health Foodservice Establishment Permit Plan Review Application Application for Virginia Department of Health Plan Review Plan Review Checklist\/Comprehensive Guide Plans to review for approval before Food Establishment Permit VA Food Regulations Virginia Department of Health Food Regulations VDH […]<\/p>\n","protected":false},"author":501,"featured_media":0,"parent":2305,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-1777","page","type-page","status-publish","hentry"],"yoast_head":"\nForms & Applications - Chesterfield Health District<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.vdh.virginia.gov\/chesterfield\/environmental-health\/forms-applications-chesterfield\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Forms & Applications - 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