Applications and Forms

  
Please print the forms below and bring with you to the health department.  You may also mail or fax your information to us.

Mail: P. O. Box 316, Leonardtown, MD 20650-0316
FAX: 301-475-4350

• Annual Operating License Application

• Application for Conventional Mound Sewage Disposal System Permit

• Application for Individual Sewage System

• Application for Open Burning Permit for Fire Instruction Permit

• Application for Swimming Pool Operating Permit

• Application for Bay Restoration Grant

• Birth Certificate Application

• Client Information Request Form

• Customer Satisfaction Survey 

• Death Certificate Application 

• Encuesta de Servicio al Cliente (Customer Satisfaction Survey Spanish)

• Environmental Health Complaint

• Health Provider Reporting Form

• Infant & Toddler Intake  

• Plan review Application Packet

• Resource Coordination Referral Intake 

• Septic Repair Application

• Special Needs Registry Form

• Temporary Food Service Facility Application

• Water Sample Request 

Forms, applications and surveys on this page are available for download or print using Adobe Acrobat Reader. You need to have Adobe Acrobat Reader installed on your system to view these documents. If you do not have Adobe Acrobat Reader click here to download.