TRAFFIC ADVISORY: NVHD IS OPEN DURING CONSTRUCTION ON RT. 67! Traffic may temporarily be re-routed to enter the parking lot from Martha St. during construction. There is a uniformed officer daily that can help direct you if this is necessary.

Free COVID-19 Test Kits are available for pick up while supplies last, please call 203-881-3255 x 118

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.

Please be advised that all formal complaints and applications must be made in person at our office or by calling 203-881-3255.  Applications may also be mailed to Naugatuck Valley Health District, 98 Bank Street, Seymour, CT 06483. Submissions made via email or submission below will not be accepted.

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.

FSE Plan Review Application & Instructions

Complete a food service plan application for a newly constructed or renovated food service establishment and to schedule an appointment.

Mobile Food Service Plan Review

Complete an Mobile Food Service plan review application for a newly constructed or renovated food service mobile kitchen. Click here for itinerant vendor guidelines..

Food Allergen Poster

Download Food Allergen Awareness poster. Available in 8 different languages.

Body Care

Use This FormIf you want to:
Body Care Plan Review

Schedule a body care plan review for a newly constructed or renovated body care 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. Including building conversions, building additions, decks, swimming pools, etc.

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 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.

Application for Septic Tank Replacement

Obtain approval for a septic tank replacement. ** Tank Only**


Use This FormIf you want to:
Site Visit Application

Request an inspection prior to the purchase of a food service establishment or body care salon.

Request for Copies

Request copies of any public records.

Tick Testing Information & Submission Form

Submit a tick for identification and/or testing.


If you submit or have submitted a tick, please complete a survey from Western Connecticut State University Tickborne Disease Prevention Laboratory. The purpose of the survey is to understand the relationship between outdoor activities and tick bites. Your response will help researchers figure out better ways to prevent Lyme Disease. Complete the survey here.