What information does the annual registration request?

It requests company and affiliate details, a local contact, information about planned improvements and facilities, and evidence of required indemnification, insurance, and bond compliance.

Who should file this registration?

Service providers that occupy or use Heath’s public right-of-way, or are responsible for services provided over a system there, should complete the registration.

Do I need a notary for the Annual Registration for Service Providers?

No. This document is signed without a notary and includes no notarized or sworn attachment; the service provider signs and dates it.

How do I submit the Annual Registration for Service Providers?

Submit it to the Division of Building and Zoning at 1287 Hebron Road, Heath, Ohio 43056. The form lists the division’s phone and fax numbers.

Heath, OH · Licking County

No notary required

Annual Registration for Service Providers

Service providers use this application to register with Heath and provide information about their company, affiliates, public right-of-way facilities, and required coverage.

What this form is

Service providers use this application to register with Heath when occupying or using the public right-of-way. It requests company and local contact details, information about affiliates, planned improvements and facilities, and evidence of compliance with indemnification, insurance, and performance or construction bond requirements. The form also includes an indemnification agreement and spaces for the provider’s signature and submission date.

Who needs it

Service providers using or occupying Heath’s public right-of-way, or responsible for services provided over facilities there, need this registration.

How to submit it

Submit it to the Division of Building and Zoning, 1287 Hebron Road, Heath, Ohio 43056. The form lists the division’s phone and fax numbers.

About notarization

This document is signed without a notary; it includes no notarized or sworn attachment, so the service provider signs and dates it.

How to submit this form

1
Download The Registration
Download the Annual Registration for Service Providers form.
2
Complete The Form
Enter company, affiliate, local contact, facility, and planned improvement information requested on the form.
3
Gather Supporting Information
Provide the requested information and evidence of compliance with indemnification, insurance, and performance or construction bond requirements.
4
Sign And Submit
Sign and date the registration, then submit it to the Division of Building and Zoning at 1287 Hebron Road, Heath, Ohio 43056.

Frequently asked questions

What information does the annual registration request?: It requests company and affiliate details, a local contact, information about planned improvements and facilities, and evidence of required indemnification, insurance, and bond compliance.
Who should file this registration?: Service providers that occupy or use Heath’s public right-of-way, or are responsible for services provided over a system there, should complete the registration.
Do I need a notary for the Annual Registration for Service Providers?: No. This document is signed without a notary and includes no notarized or sworn attachment; the service provider signs and dates it.
How do I submit the Annual Registration for Service Providers?: Submit it to the Division of Building and Zoning at 1287 Hebron Road, Heath, Ohio 43056. The form lists the division’s phone and fax numbers.

Need something notarized?

This Annual Registration for Service Providers doesn’t need a notary — but if you have another Heath form that does, a commissioned online notary can help.