The NVHD office and WIC office are currently closed to the public and walk-ins. Please call 203-881-3255 x0 to make an appointment.

For information regarding the novel coronavirus 2019 (COVID-19), visit or call 2-1-1.

Forms & Applications

The following list consists of the Naugatuck Valley Health District applications most frequently requested. If the computer used to view this site has Adobe Reader, the applications can be easily downloaded by clicking on the form name. If Adobe Reader is not installed the following link will bring you to the Adobe Website where Adobe Reader may be freely downloaded to allow the viewing of PDF formats.

Food Service

Use This FormIf you want to:
Temporary Food Service Application

Apply for a temporary food service license. Once the application is received, you will be contacted via phone prior to the event for a more detailed review. On-site inspection maybe required. For complete Guidelines for Food Service at Temporary Events click here.

Seasonal Food Service Application

Apply for a seasonal food service permit. Dates of operation by not exceed 90 calendar days.

Food Service Plan Review

Schedule a food service plan review for a newly constructed or renovated food service establishment.

FSE Plan Review Form & Instructions

Complete a food service plan application for a newly constructed or renovated food service establishment.

Food Employee Training Record

Train all non-certified food protection manager (CFPM) employees. This training must be conducted by an employed CFPM of the licensed establishment.

Request for Ratings Reinspection
Request a re-inspection for the purpose of improving the rating score given to the establishment.

Septic and Sewage

Use This FormIf you want to:
Application for Building Addition - B100

Apply for approval of a Building addition, change in use, accessory structure, lot line revision.

Request for Soil Testing/Site Evaluation

Schedule soil & site evaluation with NVHD to identify conditions on the property for septic system design proposals.

Plan Review & Approval for a New Septic System

Submit a plan to be reviewed for a new septic system design.

Plan Review & Approval for Septic System Repair

Submit a plan to be reviewed for a repair septic system design.

Application for Subdivision Approval

Submit plan(s) for review and approval of two or more lots.

Application for Review & Approval Water Treatment Wastewater (WTW) Disposal Systems

Obtain approval for an on-site well WTW disposal system.

Blank As-built

Submit an as-built.