COMMUNITY HEALTH SERVICES DIVISION
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1 COMMUNITY HEALTH SERVICES DIVISION INJURY PREVENTION PROGRAM Convertible Car Seat Distribution and Education $ $ High Back Booster Distribution and Education $ $ Backless Booster Distribution and Education $ $ Specialty Weight Seat 50 Distribution and Education $ $ Specialty Weight Seat 65 Distribution and Education $ $ TOBACCO PROGRAM Tobacco Cessation, Youth $ Tobacco Penalty (First Violation) $ Tobacco Penalty (Second Violation) $ Tobacco Penalty (Third Violation) $1, ENVIRONMENTAL HEALTH DIVISION AIR POLLUTION CONTROL I/M Station Plan Review $ Annual I/M Station Permit $ I/M Inspector Prequalifying Exam $ Inspector Training Course and Certification of Qualification $ Inspector Training Course Hourly $ Annual Fee for an Inspector s Certification of Qualification $ Inspector Transfer or Multiple Station Certification $ Air Pollution Control Fee $ 3.00 Diesel I/M Certificates (100 Count) $ Replacement Gas Metal Sign $ Replacement Diesel Metal Sign $ Diesel Study Guide $ Gas Study Guide $ Gas I/M Test $ BODY ART Body Art Facility Permit Temporary Body Art Facility Permit $ Body Art Follow-Up Inspection $ CHEMICALLY CONTAMINATED PROPERTIES Chemically Contaminated Management $ Chemically Contaminated Properties Sampling Supervision COSMETOLOGY Cosmetology Facility Permit Temporary Cosmetology Facility Permit $ Cosmetology Facility Follow-Up Inspection $ DRINKING WATER Private Water Sample $ $ per hour/per inspector
2 Public Water Sample $ FOOD PROTECTION Food Carts & Mobile Food Units Risk Level 1 $ Food Carts & Mobile Food Units Risk Level 2 $ Food Carts & Mobile Food Units Risk Level 3 $ Food Establishment Permit Risk Level 1 $ Food Establishment Permit Risk Level 2 $ Food Establishment Permit Risk Level 3 $ Food Establishment Permit Risk Level 4 $ Food Establishment Plan Review Risk Level 1 $ Food Establishment Plan Review Risk Level 2 $ Food Establishment Plan Review Risk Level 3 $ Food Establishment Plan Review Risk Level 4 $1, Food Establishment Plan Review Food Cart/Mobile Food Unit/Shaved Ice Stand $ Food Establishment Follow-Up Inspection $ Food Handler Card $ Food Safety Manager Certification $ Low Risk Seasonal Temporary Food Establishment $ High Risk Seasonal Temporary Food Establishment $ Low Risk One Day Temporary Food Establishment Permit $ Low Risk Three Day Temporary Food Establishment Permit $ Low Risk Extended Fourteen Day Temporary Food Establishment Permit $ High Risk One Day Temporary Food Establishment Permit $ High Risk Three Day Temporary Food Establishment Permit $ High Risk Extended Fourteen Day Temporary Food Establishment Permit $ Seasonal Food Cart/Seasonal Mobile Food Unit & Shaved Ice Stand Risk Level 1 $ Seasonal Food Cart/Seasonal Mobile Food Unit Risk Level 2 $ Seasonal Food Cart/Seasonal Mobile Food Unit Risk Level 3 $ Document Replacement (Food Handler Cards and Manager Certification) $ Temporary Food Establishment Late Application $ Late Notification (Extended Fourteen Day Temporary Food Establishment) $ HACCP Plan Review $ HACCP Plan Annual Renewal $ Sanitizer Test Strips $ 2.00 Thermometer $ HOUSEHOLD HAZARDOUS WASTE Conditionally Exempt Small Quantity Generators (CESQG) $ 0.43 per lb. plus state rate HOUSING No Dumping Signs $ 8.00 MASSAGE Massage Facility Permit
3 Temporary Massage Facility Permit $ Massage Facility Follow-Up Inspection $ NOISE Temporary Noise Permit $ Temporary Noise Permit Late Application $ POOLS & SPAS Summer & Winter Seasonal Operational Permit $ Year-Round Operational Permit $ Pool Facility Plan Review sq. ft. $ Pool Facility Plan Review sq. ft. $1, Pool Facility Plan Review sq. ft. $1, Pool Follow-Up Inspection $ Registered Pool Operator Permit $ PREDEMOLITION Predemolition Inspector Registration $ PUBLIC LODGING Public Lodging Facility Permit 0-49 units $ Public Lodging Facility Permit units $ Public Lodging Facility Permit 100+ units $ Public Lodging Follow-Up Inspection $ RESIDENTIAL CHILD CARE Child Care Food Service Inspection $ SOLID WASTE MANAGEMENT FACILITIES Construction and Demolition Waste Permit $ Construction and Demolition Waste Permit Tonnage $ 0.40/ton Hauler Follow Up Inspection $ Infectious Medical Waste Facility Permit for Storage or Transfer $ Infectious Medical Waste Treatment Facility Permit $ Infectious Medical Waste Facility Permit Tonnage $ 3.00/ton Liquid Waste Processing Facility Permit $ Liquid Waste Processing Facility Permit Tonnage $ 0.40/ton Monofill Permit $ Monofill Permit Tonnage $ 0.40/ton Municipal Waste Permit $ Municipal Waste Permit Tonnage $ 1.85/ton Recycling or Private Solid Waste Management Facility Permit tons/day $ Recycling or Private Solid Waste Management Facility Permit tons/day $ Recycling or Private Solid Waste Management Facility Permit 701+ tons/day $ Waste Tire Storage Facility Permit tons/day $ Waste Tire Storage Facility Permit tons/day $ Waste Tire Storage Facility Permit 701+ tons/day $ Solid Waste Management Facility Follow-Up Inspection $ SUBDIVISIONS Subdivision Plan Review $ 28.00
4 TANNING Tanning Facility Permit Temporary Tanning Facility Permit $ Tanning Facility Follow-Up Inspection $ Individual Tanning Certificate $ TEMPORARY MASS GATHERINGS Mass Gathering Permit Fee Attendance $ Mass Gathering Permit Fee Attendance $ Mass Gathering Permit Attendance $ Mass Gathering Permit Attendance 10,000+ $ Application Late Fee (Mass Gathering) $ WASTE HAULERS Infectious Medical Waste Hauler Permit (1-5 Vehicles) $ Liquid Waste Hauler Permit (1-5 Vehicles) $ Waste Hauler Permit (1-5 Vehicles) $ Waste Tire Hauler Permit (1-5 Vehicles) $ Additional Vehicle Permit (6+) $ Hauler Follow-Up Inspection $ WASTEWATER Alternate Onsite Wastewater System or Pressure Distribution $1, Permit At-Grade System Operating Permit $ Conventional Onsite Wastewater Permit $ Ground Water Monitoring Permit $ Mound System Operating Permit $ Packed Bed Media System Operating Permit $ Pressure Distribution Operating Permit $ Reinspection (Onsite Wastewater Systems) Sampling Fee $ Septic Tank or Wastewater Holding Tank Replacement $ Tank Location $ $ per hour Wastewater Holding Tank Operating Permit $ ENVIRONMENTAL HEALTH LEGAL SETTLEMENTS Negotiated FAMILY HEALTH SERVICES DIVISION CANCER SCREENING Cancer Screening UCCP $ $ PRIVATE IMMUNIZATIONS PURCHASE VFC Immunizations, Dtap $ $ $ Immunizations, DT VFC Only $ $ Immunizations, Td $ $ $ Immunizations, Tdap $ $ $ Immunizations, Hepatitis A, child (age 1yrs-18yrs) $ $ $ 14.50
5 Immunizations, Hepatitis A, adult $ Immunizations, Hepatitis B, child $ $ $ Immunizations, Hepatitis B, 19yrs $ Immunizations, Twinrix (Hep A&B) $ $ $ Immunizations, Gamma 150- $ Immunizations, Gamma 150+ $ Immunizations, Hib (Pedvax HIB) $ $ $ Immunizations, HPV $ $ $ Immunizations, HPV 9 $ $ $ Immunizations, Influenza Highdose $ Immunizations, Trivalent Influenza VFC Only $ $ Immunizations, Flu Mist $ $ $ Immunizations, Quadravelent Influenza Pres Free 6-35 mos $ $ $ Immunizations, Quadravelent Influenza Pres Free > 3 yrs and old VFC Only $ $ Immunizations Multi Dose Quad Influenza > 6 mos and older $ $ $ Immunizations, Kinrix $ $ $ Immunizations, MMR $ $ $ Immunizations, MMR-V $ $ $ Immunizations, MenB (Bexsero - OMV) $ $ $ Immunizations, MenB (Trumenba - Recombinant) $ $ $ Immunizations, Meningococcal MCV 4 $ $ $ Immunizations, Pediarix $ $ $ Immunizations, Pentacel $ $ $ Immunizations, Pneumococcal 23 $ Immunizations, Polio $ $ $ Immunizations, Prevnar 13 $ $ $ Immunizations, PPD (State) $ Immunizations, PPD $ Immunizations, PPD Reading N/C Immunizations, Rotavirus $ $ $ Immunizations, Varicella $ $ $ Immunizations, Zostavax $ Immunizations Card Replacement $ 3.00 PUBLIC HEALTH NURSING Home Visitation Initial Visit $ Home Visitation Follow Up (1 unit = 15 minutes) $ Post-Natal Tobacco Cessation $ Post-Natal Tobacco Cessation Follow-Up $ MEDICAL OFFICE DIVISION STD Office Visit (New) $ Office Visit (Established) $ Office Visit (Out of County/State) $ 60.00
6 EPI Office Visit (In County) $ EPI Office Visit (Out of County/State $ EPI Repeat $ Test C HIV Confidential $ Test A HIV Anonymous $ Office Visit Court Test #2 $ Office Visit Business License $ Prescription Re-Fill $ Pap Smear $ HSV 1 & 2 Herpes Blood $ Herpes Culture 1 & 2 $ IgG (Syphilis) $ Hepatitis C Antibody $ HCV Quantative $ HBsAG (Hepatitis B) $ HPV Treatment $ Oral GC/Chl $ Rapid Syphilis $ Rectal GC/Chl $ GC/CT $ Urine Culture and Sensitivity $ TUBERCULOSIS Case Management (1 unit = 15 minutes) $ DOT (Direct Observe Therapy) (1 unit = 15 minutes) $ TB Blood Draw $ TB Meds $ TB Meds (Re-open file) $ Quanti-Feron TB Gold $ X-RAY X-Ray, Chest, 1V $ TRAVEL CLINIC Travel Visit (first person) $ Travel Visit (second person) $ Travel Visit (third and fourth person) $ Travel Visit Booster N/C Travel Visit Other Travel Immunization, Oral Typhoid $ Travel Immunization, Typhim VI $ Replacement Typhoid $ Travel Immunization, Meningococcal $ Travel Immunization, Yellow Fever $ Travel Immunization, International Cert $ 1.00 Travel Immunizations, Yellow Fever Card-Replacement $ 5.00 Travel Immunization, Japanese Encephalitis (1-3) $ Travel Immunization, Japanese Encephalitis (Adults only) $ Travel Immunization, Rabies (1-5) $ Skin Repellant
7 Clothing Repellant Kit Replacement VITAL RECORDS Birth Certificate $ Birth Certificate, Additional Copies $ 8.00 Death Certificate $ Death Certificate, Additional Copies $ 8.00 Death Certificate Replacement Fee $ 1.00 VitalChek Birth Certificate $ VitalChek Additional Birth $ 8.00 VitalChek Death Certificate $ VitalChek Additional Death $ 8.00 MISCELLANEOUS FEES Copy Fee $ 0.25 Fax in State $ 0.50 Fax out of State $ 1.00 Employee Copy Machine / Fax $ 0.05 GRAMA Record Search (Each 15 min. after first 15 min.) $ 6.25 A $15.00 Administration Fee is included in the price of ALL vaccines. Fees based on supply costs may be changed at the discretion of the Division Director or designee. Implementation of new fee amounts will occur on the first of the following month. Sliding fees are based on family size and income according to the federal poverty guidelines.
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