{"id":213,"date":"2017-04-12T21:41:25","date_gmt":"2017-04-12T21:41:25","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/portsmouth\/?page_id=213"},"modified":"2022-10-03T09:53:26","modified_gmt":"2022-10-03T13:53:26","slug":"application-and-forms","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/portsmouth\/application-and-forms\/","title":{"rendered":"Application and Forms"},"content":{"rendered":"<p><a href=\"https:\/\/get.adobe.com\/reader\/\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-215 size-full\" src=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/acrobat.gif\" alt=\"Get Adobe Acrobat Reader graphic logo and web link.\" width=\"158\" height=\"39\" \/><\/a>\u00a0<em>NOTE: Acrobat Reader is required to view forms in PDF format.<\/em><\/p>\n<h3>Publications<\/h3>\n<ul>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/HealthDeptBrochure.pdf\">Portsmouth Health Department Brochure<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/Community-Services-Resource-Guide.pdf\">Community Services Resource Guide 2011<\/a><\/li>\n<\/ul>\n<h3 class=\"HealthTopics_Header\">Environmental Health<\/h3>\n<ul>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/ExpressWellPermitApplication.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Application for Express Class IV Well Construction Permit<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/ExpressGeothermalHeatPumpWellPermit.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Application for Express Geothermal\/Heat Pump Well Permit<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/BodyArtEstablishmentPermitAppl.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Body Art Establishment Permit Appication<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/BodyArtistPermitAppl.pdf\">Body Artist \/ Operator Permit Application<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/Commissary-Agreement.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Commissary Agreement<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/09\/Facilities-to-Maintain-Product-Temperature-Information-Sheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Facilities to Maintain Product Temperature Information Sheet<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/09\/Food-Establishment-Application.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Food Establishment Application<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/FoodEstablishmentConstructionGuidelines.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Food Establishment Construction Guidelines<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/05\/Food-Establishment-Plan-Review-Application.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Food Establishment Plan Review Application<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/09\/Food-Establishment-Plan-Review-Process-Chart.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Food Establishment Plan Review Process Chart<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/09\/PlanReviewPre-OpeningChecklist.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Food Establishment Plan Review Pre-Opening Checklist<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/Brochure-for-special-events.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Food Vendors Brochure for Special Events<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2018\/07\/Requirements-for-special-events.pdf\">Food Vendor Requirements for Special Events<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/MobileRequirementsTrifold.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Mobile Requirements Brochure<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/RecreationalWaterApp.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Recreational Water Facility Application<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/Requirements-for-special-events.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Requirements for Special Events<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2019\/03\/Temporary-Food-Establishment-Permit-Application.pdf\">Temporary Food Establishment Permit Application<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/09\/Worksheet-for-Calculating-Minimim-Hot-Water-Requirements.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Worksheet for Calculating Minimim Hot Water Requirements<\/a><\/li>\n<\/ul>\n<h3 class=\"HealthTopics_Header\">Vital Records<\/h3>\n<ul>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/PHDDeathCert.pdf\">Application for Certification of a Vital Record and ID Requirements Form<\/a><\/li>\n<\/ul>\n<h3 class=\"HealthTopics_Header\">WIC<\/h3>\n<ul>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/WIC-349.pdf\">Referral to the Virginia Special Supplemental Nutrition Program for Women, Infants and Children (WIC-349)<\/a><\/li>\n<li><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/125\/2017\/04\/WIC-395.pdf\">Virginia Request for Special Food Package (WIC-395)<\/a><\/li>\n<\/ul>\n<h3 class=\"HealthTopics_Header\">Others<\/h3>\n<ul>\n<li><strong><a title=\"Virginia State Application Forms\" href=\"http:\/\/jobs.virginia.gov\/emplApplication.html\" target=\"_blank\" rel=\"noopener noreferrer\">Virginia State Application Forms<\/a><\/strong><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>\u00a0NOTE: Acrobat Reader is required to view forms in PDF format. Publications Portsmouth Health Department Brochure Community Services Resource Guide 2011 Environmental Health Application for Express Class IV Well Construction Permit Application for Express Geothermal\/Heat Pump Well Permit Body Art Establishment Permit Appication Body Artist \/ Operator Permit Application Commissary Agreement Facilities to Maintain Product [&hellip;]<\/p>\n","protected":false},"author":129,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-213","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Application and Forms - Portsmouth 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\/portsmouth\/application-and-forms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Application and Forms - Portsmouth Health District\" \/>\n<meta property=\"og:description\" content=\"\u00a0NOTE: Acrobat Reader is required to view forms in PDF format. 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