(a) In all counties, except counties of the first class, single-county departments of health or joint-county departments of health may be authorized by resolution or by referendum, or by a combination of these methods, as provided in this section. In the authorization of joint-county departments of health, each of the participating counties shall be adjacent to at least one of the other participating counties.

Whether a county department of health is authorized by resolution or by referendum or by a combination of these methods, the county commissioners shall, before enacting a resolution or before submitting the question at an election, request a certificate of approval from the State Secretary of Health, who shall issue such a certificate forthwith if the proposed county department of health conforms to the county health administration plan as last revised. If the proposed county department of health does not conform to the county health administration plan as last revised, the State Secretary of Health shall make a special investigation in accordance with the criteria stated in section 4.¹ of this act and, on the basis of the special investigation he shall approve or disapprove the establishment of the proposed county department of health. He shall send a certificate of approval or written notice of disapproval to the county commissioners within thirty (30) days after he has received the request for a certificate of approval.

(b) The county commissioners of any county may, by resolution, authorize the establishment of a single-county department of health. The county commissioners of two or more counties may, by a separate resolution in each county, authorize the establishment of a joint-county department of health. In either case, the approval of the State Secretary of Health shall be first obtained as provided in subsection (a) of this section.

(c) Any county may, by referendum, authorize the establishment of a single-county department of health. Two or more counties may, by a separate referendum in each county, authorize the establishment of a joint-county department of health. The referendum procedure in each county shall be as follows:

A petition requesting the establishment of a single-county department of health or joint-county department of health shall be signed by qualified electors of the county equal in number to at least one per cent (1%) of the highest total vote cast for any county office at the last municipal election. The petition shall be in the form required for nomination petitions by the election laws of the Commonwealth, except that the petition shall be circulated for not more than six (6) months prior to the last filing day, which shall be ninety (90) days before the general or municipal election at which it is desired to submit the question. The petition shall be filed with the county board of elections, and the validity of the petition and any objections thereto shall be determined in accordance with the election laws of the Commonwealth.

After the validity of the petitions in all the counties affected has been determined, the county commissioners shall request a certificate of approval from the State Secretary of Health. If the approval of the State Secretary of Health is obtained as provided in subsection (a) of this section, the county commissioners shall cause the question to be submitted at the next general or municipal election, whichever is sooner, so long as such election is to occur at least thirty (30) days after the receipt of a certificate of approval. The question shall be submitted on the ballot or on voting machines in the manner provided by the election laws of the Commonwealth, and shall be in substantially the following forms:

The election on this question shall be governed in all respects by the election laws of the Commonwealth insofar as they are applicable. For the establishment of a single-county department of health or joint-county department of health, a majority of all votes cast in each county upon the question must be in favor thereof.

Nothing in this subsection shall be construed to preclude the county commissioners at any time from authorizing the establishment of a single-county department of health, or from joining in the establishment of a joint-county department of health, by resolution in accordance with subsections (b) and (d) of this section.

(d) Two or more counties may authorize the establishment of a joint-county department of health by a combination of the methods provided in subsections (b) and (c) of this section; that is, one or more of such counties may join in the establishment of a joint-county department of health by resolution, and the remaining counties may join in the establishment of a joint-county department of health by referendum in accordance with the provisions of subsection (c) of this section.

(e) Immediately upon the authorization of the establishment of a single-county department of health or joint-county department of health, the county commissioners shall give written notice thereof to the State Secretary of Health. In the case of a joint-county department of health, the notice may be given by the county commissioners of any participating county.