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ENVIRONMENTAL HEALTH FY 20/21 PERMIT FEE WAIVER REQUEST APPLICATION

  1. Instructions

    The Environmental Health Department Permit Fee Waiver Request Application is in response to the severe impact that COVID -19 Restrictions and State Public Health Mandates have impacted certain Businesses in our County. The Waiver is intended to provide some relief to the following business types: Restaurants, Bars/Breweries, Public Pools and Spas, Body Art and Tattoo Facilities and Organized Campgrounds for the operational period of October 31, 2020 through November 1, 2021. If you wish to submit a request from, please review and complete all areas of the Waiver Request Application below and on subsequent pages. Please note that you must complete all information and submit to the Nevada County Department of Environmental Health by November 30, 2020 to be considered for the FY 20/21. Submittals after November 30, 2020 will not be considered.

  2. Please complete the following information as accurately as possible:

  3. Type of business (please check your current permit category):

  4. Restaurant

  5. Bar/Brewery

  6. Public Pool and Spa

  7. Body Art and Tattoo

  8. Organized Campground

  9. Statement should include information on the number of days your business was shuttered and relevant fiscal impacts as a result of COVID-19

  10. Has your Business’s Account remained in good status with the Environmental Health Department from October 31, 2019 through the present?*

  11. Please review and check next to each of the following Application Terms:*

    Review and check all items in the following section. By checking each box below, you are accepting of the terms of this Waiver Application. Failure to comply with current COVID-19 State Orders or Local Public Health Mandates will result in the reversal of the Waiver and all fees will be due in full along with any fines assessed for non-compliance.

  12. Leave This Blank:

  13. This field is not part of the form submission.