HomeMy WebLinkAbout017-300-026 WH-WWP-26-0228 25-127_ButteCo_ConstApp_Signed
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APPLICATION Form CP
APN #: TrakIt #:
Applicant Name (Please print) Property Owner Name
Applicant Mailing Address Construction Site Address
City State Zip City State Zip
Applicant Telephone Number Certified Designer (if applicable)
☐ New Construction ☐ Repair
☐ Expansion ☐ Tank Destruction Certified Installer (if applicable)
☐ Tank Replacement Only
☐ Residential: Number of bedrooms:
☐ Non-Residential (specify): Applicant Signature Date
DESIGN AND CONSTRUCTION APPROVAL
This permit is issued based on review of the attached design and has determined that it meets the re-
quirements of Butte County Code Chapter 19 On-Site Wastewater Systems.
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Environmental Health Specialist Date of Issuance
Comments/Conditions:
� This permit valid only for installation of attached design, stamped “Approved.” Variation from the ap-
proved design must have prior approval by Environmental Health.
� This permit valid only if system is installed by the homeowner or by a contractor with valid Installer
Certification issued by Environmental Health.
� This permit will expire 2 years from the date of Design and Construction approval.
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FINAL APPROVAL AND CERTIFICATE OF
Installation by: ☐ Homeowner ☐ Certified Installer ☐ As-Built Attached ☐ Designer Sign-off
Inspected by: Comments:
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Environmental Health Specialist Date
White – Environmental Health copy Yellow – Customer copy: Final approval Pink – Customer copy: Permit Update: December 14, 2020
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Environm
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al Health
ON-SITE
CONSTRUCTION P
Date: _
Amount:
Receipt No.
This application will be accepted with payment of permit fee and the permit will be issued when system design is submitted
by a Certified Designer (or Certified Installer for Standard Gravity System) and approved by Environmental Health.
7/06/2026
PO Box 1810
Chico,CA 95927
(530) 520-2939