Environmental Division Applications, Forms & Documents


Environmental Health DivisionPlanning, Building & Environmental Services

Farmers Market

Retail Plan Check Guide for Food Facilities Pool-Fecal, Vomit, Blood and Drowning Incident Protocol Pool-Fecal, Vomit, Blood and Drowning Incident Protocol

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

Application for Wastewater Hauling Permit

Business Activity Page


Temporary Event Organizer Application

ASTS Plan Submittal Checklist 2012



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

Groundwater Application 2012



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 Application 2012 



Pool Plan Check Application Worksheet 2013

Monitoring Well Permit Application 




Pumper Truck Application Form




Record Update Form (RUF)-Onsite Wastewater




Service Provider Application 




Soil Boring Permit Application




Supplemental Application for ASTS




Supplemental Application for NEW OWNERS 



Pamphlets to help you avoid common pitfalls 

Water Well Construction Application



Best Stormwater Management Practices for Food Facilities  

Water Well Destruction Application



Best Stormwater Management Practices for Food Facilities  




Best Stormwater Management Practices for Food Facilities  




B & B Pool Sign

  Pamphlets to help you avoid common pitfalls

  Pamphlets to help you avoid common pitfalls 

  Pamphlets to help you avoid common pitfalls 


ASTS Landscaping Guidelines 

Welcome Packet

Agreement, Solid Waste, Recyclable Materials, Green Waste Collection

Food Demonstration and Sampling Requirements

ASTS Service Providers List 2013


Clinic Ole Expired Medication

Food Facility Person in Charge

 ASTS Standards-Final Draft Document-November   


Sharps Disposal Guide

Food-Notice of Availability of Inspection Report

Backwash Guidelines May 2011 



Food-One Day Non Profit Temp Event Checklist

Building Permit Requirements-Well -Septic



Food Safety Certification Providers 2012

Groundwater Permit Handout



Food-Trans Fat Ban CCDEH

Hold and Haul for Winery Wastewater Guidelines



Food Waste Flyer for Food Facilities

Napa County Approved List of Leach Field Chambers



Menu Labeling Guidelines from CCDEH

Percolation Test Guidelines 



MHP Inspection Guidelines for Residents  

Septic Tank Destruction Guidelines



Mobile Food Facility Information Regarding Other Napa County Agencies  

Sewage Permit Issuance Requirements Updated 2012   



Outdoor Beverage Bar Guidelines

Sewage System Contractors



Pools-Cyanuric Acid  

Site Evaluation Guidelines



Pool-Fecal, Vomit, Blood and Drowning Incident Protocol  

Site Evaluation Professional List April 2017



Pool-Fecal, Vomit, Blood and Drowning Incident Record  

Spring Water Supply Requirements



Retail Plan Check Guide for Food Facilities

Steps to construct and final and ASTS



Service Animals in Food Facilities 2011

Wastewater Pond MOU 



Swimming Pool Maintenance

Wastewater Pumper Trucks 



Swimming Pool Maintenance

Well Destruction Guidelines-2013 



Water Contaminant Arsenic Fact Sheet

Well Owner Guide-State Water Board 



Water Contaminant Coliform Fact Sheet

Well Reconstruction Guidelines



Water Contaminant Nitrate Fact Sheet 

Well Septic ElectricalFloodplain Memo



Water-Interpreting Drinking Water Test Results

Winery Pond FAQ



Water Systems-Permit Instructions

Winery Pond Fencing and Sign Requirements 



Water-Spring Guidelines

Winery Pond Online Reporting



Water Testing Laboratories 

Winery Pond Reporting Requirements  


Water Well Chlorination Instructions




Water Well Testing FAQ from CDC 
















  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 

ASTS Septic System Self Monitoring Report



Fish Truck Compliance Agreement

At-Grade System Inspection Form



Food Plan Check Hood Performance Test

Burned Dwelling Replacement Guidelines



Handwash Sign

Contractor Inspection Report Form



Hotdog and Coffee Carts Compliance Agreement 

Conventional System Inspection Report Form



Ice Cream Truck Compliance Agreement 

Deed Restriction Well Destruction in Septic Reserve Area



MFF Pre-Packaged Food Vehicle

Electrical Certification Form



Mobile Food Facility Compliance Agreement

ElectricalPermit Water Well Septic Tank – No Associated Structure



Pools-Anti-Entrapment Devices Compliance Form

Electrical Permit Water Well  Septic Tank – With Structure



Produce Truck Compliance Agreement

Evaportanspiration Infiltration Bed Inspection Form



Swimming Pool Operating Records

Future Dwelling Agreement 



TFF Temp Event Food Booth Self Inspection Checklist

Future Winery Agreement



TFF Fee Waiver Request Form

Grease Trap Agreement



Water Agreement for Grant of Water Rights

Instructions for Water Agreement



Water Bacteriological Siting Plan 2013

Mound System Inspection Report



Water-Instructions for Agreement for Grant of Water Rights

Pressure Distribution Inspection Report



Water System Disinfection Byproduct Plan

Site Evaluation Report Form



Water System Emergency Notification Plan

Subsurface Drip System Inspection Report




Surface Drip System Inspection Report



  Watertight Certification Form