HomeMy WebLinkAbout027-260-009 EH-SE-26-0151 Septic Application updatedAPPLICATION 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.
__
Environmental Health Specialist Date of Issuance
Comments/Conditions:
This permit valid only for installation of attached design, stamped Approv 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.
FINAL APPROVAL AND CERTIFICATE OF
Installation by: Homeowner Certified Installer As-Built Attached Designer Sign-off
Inspected by: Comments:
_
Environmental Health Specialist Date
White Environmental Health copy Yellow Customer copy: Final approval Pink Customer copy:Permit Update:December 14, 2020
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.
Rhonda Berndt de Pineda for Phillip DeCann
6221 Clark Rd
Paradise, CA 95969
5308772430
Phillip DeCann
10/5/26
Bailey
7725 Reservoir Rd
Oroville, CA 95966
X 5
x
027-260-009