{"id":1510,"date":"2026-04-24T12:28:59","date_gmt":"2026-04-24T12:28:59","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/piedmont\/?page_id=1510"},"modified":"2026-04-27T13:51:10","modified_gmt":"2026-04-27T13:51:10","slug":"forms-applications","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/piedmont\/forms-applications\/","title":{"rendered":"Forms & Applications"},"content":{"rendered":"

Forms & Applications<\/h1>\n
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Food Service Applications, Forms, & Regulations<\/caption>\n
Name:<\/b><\/th>\nDescription:<\/b><\/th>\n<\/tr>\n
Food Permit Application<\/a><\/strong><\/td>\nApplication for a Virginia Department of Health Foodservice Establishment Permit<\/td>\n<\/tr>\n
Plan Review Application<\/a><\/strong><\/p>\n

*Submit the Plan Review Application and the Food Permit Application to:<\/p>\n

Piedmont Health District<\/strong><\/p>\n

\u00a0111 South St, Ground Floor<\/strong><\/p>\n

Farmville, VA 23901<\/strong><\/td>\n

Application for Virginia Department of Health Plan Review<\/td>\n<\/tr>\n
VA Food Regulations<\/strong><\/a><\/td>\nVirginia Department of Health Food Regulations<\/td>\n<\/tr>\n
Mobile Unit Fire Inspection Checklist<\/a><\/strong><\/p>\n

Mobile Unit Fire Inspection Contract<\/a><\/strong><\/p>\n

Mobile Unit Plan Review<\/a><\/strong><\/td>\n

Virginia Department of Health required Mobile Unit forms<\/td>\n<\/tr>\n
Temporary Food Event Vendor Application<\/a><\/strong><\/p>\n

*To apply for a Temporary Food Establishment Permit, submit a completed application and fee of $40 to the local health department in which the TFE will be located.<\/td>\n

Application for a Temporary Food Establishment which must be submitted\u00a010<\/strong>\u00a0business 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
Temporary Food Event Coordinator Application<\/a><\/strong><\/td>\n\u00a0Event coordinators should submit the application\u00a0at least 30 calendar days before the event\u00a0in order to assist in the review of the individual temporary food establishment applications.<\/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\/Tourist Establishment Permit Application<\/a><\/strong><\/td>\nApplication for a Hotel or Tourist Establishment permit<\/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><\/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

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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>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Forms & Applications Food Service Applications, Forms, & Regulations Name: Description: Food Permit Application Application for a Virginia Department of Health Foodservice Establishment Permit Plan Review Application *Submit the Plan Review Application and the Food Permit Application to: Piedmont Health District \u00a0111 South St, Ground Floor Farmville, VA 23901 Application for Virginia Department of Health […]<\/p>\n","protected":false},"author":699,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","inline_featured_image":false,"footnotes":""},"tags":[],"class_list":["post-1510","page","type-page","status-publish","hentry"],"yoast_head":"\nForms & Applications - Piedmont 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\/piedmont\/forms-applications\/\" \/>\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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