Yreka, CA · Siskiyou County
Environmental Health and Air Pollution Form
This form collects project and business information about hazardous materials, school proximity, and potential air pollution for Yreka building permit applicants.
What this form is
The City of Yreka Building Department requires this completed form before approving a building permit, except for applications solely for residential construction. It asks for applicant and site details and answers about hazardous materials, hazardous waste, proximity to a school, and possible air pollutants. Applicants who answer yes to specified questions are directed to contact the relevant county office for project review.
Who needs it
Applicants seeking a Yreka building permit, other than for residential construction alone, need to complete and submit this form.
How to submit it
Submit the original to the City of Yreka Building Department, 701 Fourth Street, Yreka, CA 96097. The form lists copies for the county environmental health department, county air pollution office, and Yreka Fire Department.
About notarization
This document is signed and dated without a notary; it lists no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the Environmental Health and Air Pollution Form.
- 2
Complete The Form
Provide applicant and site details, answer the questions, and sign and date the certification.
- 3
Review The Contact Instructions
If you answer yes to the specified questions, contact the county office identified on the form for project review.
- 4
Submit To The City
Submit the original to the City of Yreka Building Department at 701 Fourth Street, Yreka, CA 96097.
Frequently asked questions
- Who needs to complete the Environmental Health and Air Pollution Form?
- Applicants for a Yreka building permit must complete it, except when the application is solely for residential construction.
- What information does the form ask for?
- It asks for applicant and site information and answers about hazardous materials and waste, school proximity, and potential air pollutants.
- How do I submit the Environmental Health and Air Pollution Form?
- Submit the original to the City of Yreka Building Department at 701 Fourth Street, Yreka, CA 96097. The form also lists county offices and the Yreka Fire Department for copies.
- Do I need a notary for this form?
- No. This document is signed and dated without a notary, and it lists no notarized or sworn attachment.
Need something notarized?
This Environmental Health and Air Pollution Form doesn’t need a notary — but if you have another Yreka form that does, a commissioned online notary can help.