HomeMy WebLinkAbout065-320-011 EHS24-0246 SEPTIC REPAIR APPLICATAIONButte County
This
section
completed
by
applicant
PUBLIC HEAiTH
This
section
completed by
Environmental
Health
APN #:
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.
C6S-320-ojl
Ete Exca Jati ad Seic
Applicant Name (Please print) Gal Uitsinia
Applicant Mailing Address toradise
City
D New Construcion
O Expansion
CA
530-S14-4432
Applicant Telephone Number
ON-SITE WASTEWATER
CONSTRUCTION PERMIT
Tank Replacement Orty
lay
State
Comments/Conditions:
Repair
Residental: Number of bedrooms:
O Non-Residential (specity):
Environmental Heath Specialist
Installation by:
Inspected by:
I Tark Destrucion
White-Environmental Heatth copy
5767
Zp
2
APPLICATION
Env1ronmental Health Speciaist
Trakit #
Sara Sülhvan
"Cldcone
Corsrucio Site Address Maçalia City
Date
Certified Designer (f appicabie)
Appicant Signature
PERMIT
DESIGN AND CONSTRUCTION APPROVAL
CA
State
Heve Gonals
Date of Issuance
Date
Amoun:
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 Or-Site Wastewater Systems.
" This permit will expire 2 years from the date of Design and Construction approval.
Receipt No.
De.
95954
This permit valid oniy for installation of attached design, stamped Approved." Variation from the ap
proved design must have prior approval by Environmental Health.
Pink-Customer copy: Permit
This permit valid only if system is installed by the homeowner or by a contractor with valid lnstaler
Certification issued by Environmental Heath.
FINAL APPROVAL AND CERTIFICATE OF COMPLETION
Form CP
Date
Zip
Homeowner Certified lnstaller O As-Buit Attached O Designer Sign-off
Comments:
Yellow -Customer copy Final approval Update: December 14, 2020
OUR MISSION IS To PROTECT THE PUBLIC THROUGH PROMOTING INDIVIDUAL. COMMUNITY AND ENVIRONMENTAL HEALTH