Forms & Licensing

Business Group	Business Type	Form Name	Form
Campgrounds	Campgrounds	Campground Registration	Campground Registration Form rev2021
Construction & Septic	Construction	B100a Form (addition/shed/pool/etc) Sample Plot Plan	Construction Forms
Construction & Septic	Demolition	Demolition Requirements DPH Demolition Notification Form	Demolition Forms
Construction & Septic	Septic – New / Renovation	Septic application -New or Renovation Application for Septic System, Site Plan, and Subdivision Plan Review Application for Septic System Inspection and Certification Notarized Statement for Homeowner to Install Operation and Maintenance of a Subsurface Sewage Disposal System	Septic Forms
Construction & Septic	Water Treatment Waste Water	Application for the Installation of a Water Treatment Wastewater System (WTW)	Application for the Installation of a Water Treatment Wastewater System (WTW)
Daycare		Daycare Inspection Request form rev 1018	Daycare Inspection Request form rev 1018
Food Service	Food Service	Food Service License Application Food And Safety Training (FAST) Class Food Service Plan Review Application Food Service Plan Review Application, renovations to existing Alternate Person In Charge Demonstrated Knowledge Statement Food Service FORM 1-B Employee Training Record Guideline for Classifying Food Service Establishments Fee Schedule Choking Poster - English Choking Poster - Spanish Chinese Training Forms Hot Food Holding Log	Food Service Forms
Food Service	Food Service Renewal	Food Establishment’s Renewal Paperwork Food Service License Application Employee Training Record Designated Alternate Form Food Service Form 1-B	Food Establishment’s Renewal Paperwork
Food Service	Temporary Event	Temporary Event	Temporary Event Application rev Jul1422
Group Home		Request for an Inspection of a Group Facility	Request for an Inspection of a Group Facility
Public Pools		Public Swimming Pool Registration Form Disinfectant Levels Daily Log Sheet for Swimming Pool	Public Pools Forms
Salon		Salon Application to Operate a Salon or Barbershop Salon Review Application for a Salon or Barbershop Salon Regulations Salon Floor Plan Template Salon Disinfection Guide	Salon Forms
Tattoo Facility		Tattoo Facility NEW Registration Form	Tattoo Facility NEW Registration Form rev Feb22
UNCAS	Fee Schedule	UNCAS Health District Fees Schedule	UNCAS Health District Fees Schedule
UNCAS FORMS		Uncas Health District Employment Application UNCAS Request For Public Info	UNCAS FORMS

Address
Campbell Building
401 W. Thames Street, Suite 106
Norwich, CT 06360

Office Location
Park in the back of the Campbell Building
Enter through the Credit Union entrance

Contact Us
Our office is available Monday - Friday 8:00 am - 4:00 pm for all of the residents in our district.

p 860-823-1189
f 860-887-7898
e doh@uncashd.org

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