Get Environmental Health Permit Application - County Of Santa Clara - Sccgov

Filling out the Environmental Health Permit Application for the County of Santa Clara is an essential step for ensuring compliance with local health regulations. This guide provides clear instructions to support you through the process of completing this application online.

Follow the steps to successfully complete your application

1. Click the ‘Get Form’ button to access the application form and open it in the editor.
2. Provide the owner's information at the top of the form. Fill in the last name and first name of the owner. If the owner is a corporation, list the name of the corporation.
3. Indicate the 'Doing Business As' (DBA) name, if applicable, and fill in the owner's address, including street number, street name, unit number, city, state, and zip code.
4. List any other businesses owned by the applicant. Provide the owner's telephone and fax numbers, as well as a cell phone number for contact.
5. If applicable, include a third mailing address with complete details such as street number, street name, city, state, and zip code.
6. Fill in the in-care-of information, providing the name of the individual or organization responsible for receiving the mail.
7. Enter the facility name and the number of employees at the facility. Provide the full facility address, including street details, city, state, and zip code.
8. Provide contact numbers for the facility, including telephone, fax, and cell phone numbers.
9. Select the billing address option — whether it is the owner's, the facility's, third mailing address, or care of. If 'Care Of' is selected, fill in the appropriate contact details.
10. Review the agreement statement regarding the operation under applicable laws and regulations. Include your signature, title, date, and printed name in the designated areas.
11. Complete any change of status information and comments if required. Acknowledge any changes relevant to ownership or facility status.
12. After verifying all information is correct, save your changes, and consider downloading, printing, or sharing the completed form as needed.

Begin the application process and complete your Environmental Health Permit Application online today.