Environmental Division Applications, Forms & Documents


Environmental Health DivisionPlanning, Building & Environmental Services

Farmers Market


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Environmental Health

Code Compliance


Applications, Additional Forms & Information

Finding What You Want:

The Environmental Health Division has a number of applications, submittal forms and informational documents to help you with your Environmental Health and Land Use needs. If you can't find what your looking for using the links below, or not sure exactly what you need, Environmental Health Division staff is available to help. Staff is available for consultation and application services weekdays (excluding holidays) from 7:30 am to 4:15 pm. If you have questions about applications, permitting, health codes, violations, or general food and establishment safety use the informational links provided, or feel free to contact us for assistance.

Available Documents:



Consumer Protection


Land Use


 Pollution Prevention 


Solid Waste 






  Applications for Consumer Protection

  Applications for Land Use

  Applications for Pollution Prevention

  Applications for Solid Waste

Temporary Event Vendor Application

Wastewater Hauling Permit

Business Activity Page


Temporary Event Organizer Application

ASTS Plan Submittal Checklist



Cottage Food Operation Permit Class B

Conventional Sewage Disposal Application Form



Cottage Food Operation Registration Class A

City of St. Helena Well Permit Application 



Current Record Update Form 06-13

Geothermal Heat Exchange Well Application



Farmers Market Organizer Application

Discretionary Groundwater Permit Application



Water System Permit Amendment Application

Instructions for Completing Groundwater Permit Application



Water System Permit Application 

Instructions-Supplemental App. and RUF



Plan Check Application for Food Facilities

Ministerial Groundwater Permit Application



Pool Plan Check Application Worksheet 2013

Monitoring Well Permit Application 




Record Update Form (RUF)-Onsite Wastewater  




Soil Boring Permit Application  




Supplemental Application for ASTS  




Supplemental Application for NEW OWNERS 




Water Well Construction Application




Water Well Destruction Application



Pamphlets to help you avoid common pitfalls 




Best Stormwater Management Practices for Food Facilities  




B & B Pool Sign








Food Demonstration and Sampling Requirements 

  Pamphlets to help you avoid common pitfalls

  Pamphlets to help you avoid common pitfalls 

  Pamphlets to help you avoid common pitfalls 

Food Facility Person in Charge 

ASTS Landscaping Guidelines 

Welcome Packet

Agreement, Solid Waste, Recyclable Materials, Green Waste Collection

Food-Notice of Availability of Inspection Report

ASTS Service Providers List


Clinic Ole Expired Medication

Food-One Day Non Profit Temp Event Checklist

ASTS Standards


Sharps Disposal Guide

Food Safety Certification Providers

Backwash Guidelines



Food Waste Flyer for Food Facilities

Building Permit Requirements-Well -Septic



Hot Dog and Coffee Cart Compliance Agreement

Groundwater Permit Handout



Menu Labeling Guidelines from CCDEH

Napa County Approved List of Leach Field Chambers



MHP Inspection Guidelines for Residents

Septic Tank Destruction Guidelines



Mobile Food Facility Information Regarding Other Napa County Agencies      

Outdoor Beverage Bar Guidelines

Sewage Permit Issuance Requirements Updated 



Preventing Food Cross Contamination  

Sewage System Contractors



Pools-Cyanuric Acid  

Site Evaluation Guidelines



Pool-Fecal, Vomit, Blood and Drowning Incident Protocol

Site Evaluation Professional List



Pool-Fecal, Vomit, Blood and Drowning Incident Record      

Retail Plan Check Guide for Food Facilities

Spring Water Supply Requirements  



Service Animals in Food Facilities  

Steps to construct and final ASTS  



Swimming Pool Maintenance  

Wastewater Pumper Trucks   



Water Contaminant Arsenic Fact Sheet

Well Destruction Guidelines  



Water Contaminant Coliform Fact Sheet

Well Owner Guide-State Water Board    



Water Contaminant Nitrate Fact Sheet 

Well Septic ElectricalFloodplain Memo   



Water Systems-Permit Instructions

Winery Pond FAQ  



Water-Spring Guidelines

Winery Pond Fencing and Sign Requirements    



Water Testing Laboratories 

Winery Pond Reporting Requirements



Water Well Chlorination Instructions




Water Testing FAQ from from CDC for Private Wells



































  Supplemental forms depending upon Application

  Supplemental forms depending upon Application

  Supplemental forms depending upon Application

  Supplemental forms depending upon Application

Authorized Agent Form

Agreement for Grant of Easement and Water Rights

 Emergency Response Plan 020813


Commissary - Restroom Verification Form for Mobile Food Facilities

Agreement for Grant of Sewage Easement



Cottage Food Operation Planning Department Authorization Form 

Burned Dwelling Replacement Guidelines



Fish Truck Compliance Agreement

Contractor Inspection Report Form



Food Plan Check Hood Performance Test

Deed Restriction Well Destruction in Septic Reserve Area  



Handwash Sign

Future Dwelling Agreement 



  Future Winery Agreement  



Ice Cream Truck Compliance Agreement 

Grease Trap Agreement  



MFF Pre-Packaged Food Vehicle

Instructions for Water Agreement  



Mobile Food Facility Compliance Agreement

Site Evaluation Report Form



Pools-Anti-Entrapment Devices Compliance Form

Watertight Certification Form



Produce Truck Compliance Agreement




Swimming Pool Operating Records




TFF Temp Event Food Booth Self Inspection Checklist




TFF Fee Waiver Request Form




Water Agreement for Grant of Water Rights




Water Bacteriological Siting Plan




Water-Instructions for Agreement for Grant of Water Rights




Water System Disinfection Byproduct Plan




Water System Emergency Notification Plan