Ventura County Environmental Health Division
800 S. Victoria Ave., Ventura CA 93009-1730
TELEPHONE: 805/654-2813 or FAX: 805/654-2480 :
Website: www.vcrma.org/divisions/environmental-health
INSPECTIONS ONLY: 805/477-7136
PERMIT TO CONSTRUCT AN ONSITE WASTEWATER TREATMENT SYSTEM (OWTS)
INSTRUCTIONS:
1. Check one: This Permit to Construct is for (check one):
NEW___ REPAIR___ ABANDONMENT___
2. Check one: I am the
Property Owner ___ Licensed Contractor ___ Property owner’s authorized agent ___
3. If NEW, complete items 1 and 6 below.
4. If REPAIR, complete items 1 and 6, plus, if applicable, items 2, 3, 4, and 5 below.
5. If ABANDONMENT, complete items 1, 3, and 6 below.
6. If you are the owner’s authorized agent, be advised the following two forms MUST be
completed and submitted with the application, or the application will NOT be accepted:
a. Authorization of Agent
b. Notice to Property Owner
7. If you are the owner, complete this form:
Notice to Property Owner
8. For REPAIR or ABANDONMENT, provide a plot plan showing the system location.
9. For NEW, REPAIR, or ABANDONMENT, provide a signed Certificate of Compliance with
Construction Safety Requirements.
10. Request for inspection must be made at least 24 hours in advance, excluding
Saturdays, Sundays, and holidays.
11. This Permit to Construct application expires in 180 days.
FOR OFFICE USE ONLY
Recd By: _______________________________________________ Date: _____________
Amount Received: _______________________________________ Check No.: _________
Receipt No.: ____________________________________________
Design Reviewed By: _____________________________________ Date: _____________
Issued By: ______________________________________________ Date: _____________
Construction Installation
Approved By: ___________________________________________ Date: _____________
Intended Use: ______________________________________________________________
JA G:ADMIN/TECH SERVICES/Office Forms/Forms/P2C OWTS 4-18
DISTRIBUTION:White/Yellow-EHD Pink-Owner Goldenrod-Contractor
For REPAIR only
EHD ON #:_____________________
3. BUILDING
4. SEPTIC TANK
5. LEACH LINES
Type of Development:
Residential:
No. of Bedroom Equivalents _______No. of Fixture Units ____________
Commercial:
Number of Fixture Units _________________________________________
Maximum No. Employees/Visitors _________________________________
Water Supply:
Public: Name of Water Company ________________________________
Private _______________________________________________________
Type of absorption system:
Leach Line Seepage Pit Mound System
Subsurface Filter: Length______x Width_______=________Total Sq. Ft.
Number of Tanks _________________________________________________
Capacity of Each Tank ____________________________________________
Leach Line Installation
Number of trenches _____________ on __________ foot centers
Length of each trench ________________________________ feet
Bottom width of trench ________________________________ feet
Earth cover over drainline _____________________________ feet
Rock under drain line _________________________________ feet
Total depth of each trench ____________________________ feet
Square feet/lineal feet of trench ________________________
Absorption area provided _____________________________ sq. feet
Untreated
building paper
Use clean rock
3
/
4
in. to 2
1
/
2
in.
Rock under pipe
4 in. perforated PVC or ABS pipe
Total trench
depth
feet
feet
feet
Earth Cover
feet
Trench width
2 in. Rock
2. SEEPAGE PITS
Seepage Pit Installations
Number of pits _______________________________________
Diameter of each pit __________________________________ feet
Earth cover over pits _________________________________ feet
Effective depth of each pit ____________________________ feet
Total depth of each pit _______________________________ feet
Absorption area provided _____________________________ square feet
Use clean rock
3
/
4
in. to 2
1
/
2
in.
From septic tank
4 in. perforated PVC
or ABS pipe
feet
feet
feet
feet
Asphalt treated
building paper
Effective depth
Earth Cover
Total depth
Diameter
1. SITE INFORMATION
Project Address Locality
Owner's Name Nearest Cross Street
Assessor Parcel Number
_ _ _ –
0
– _ _ _ – _ _ _
Phone
Mail Address City, State, Zip
E-mail Address
Agent/Contractor Phone
Agent/Contractor Address City, State, Zip
Read and sign below; PLUS, complete a 2
nd
LEGAL DECLARATIONS form.
GENERAL ACKNOWLEDGEMENT (FOR ALL APPLICANTS)
I certify that I have read this application and state that the above information is correct. I agree to comply with all county ordinances and state laws
relating to OWTS construction, and hereby authorize representatives of this city and county to enter upon the above mentioned property for inspection
purposes. I further certify that no public sewer is available within 200 feet of the proposed OWTS or structure(s) served by the OWTS.
Additionally, I understand that Section 105.5 of the Ventura County Building Code (VCBC) 2010 Edition states that: “Every permit issued by the
Building Official under the provisions of this Code shall expire by limitation and become null and void, if the building or work authorized by such permit
is not commenced within 180 days after the date of issuance of such permit or if the building or work authorized by such permit is suspended or
abandoned at any time after the work is commenced for a period of 180 days, or if the work authorized by such permit does not receive final inspection
approval within 3 years from the issuance date of the permit”. For permit expiration purposes, “SUSPENDED OR ABANDONED” shall be measured as
elapsed time between “APPROVED REQUIRED INSPECTIONS” as delineated in 2010 CBC Appendix Chapter 1, Sections 110.1 through 110.3.10.
I further understand that I will not be notified by the County of Ventura prior to expiration of permit.
Print Name _____________________________________________________________________________
________________________________________________________________________________________
Date _____________________
Signature of Property Owner, Owner’s Authorized Agent, or Contractor
6. DECLARATIONS
Please take a moment to provide feedback. An opinion form can be completed at
http://www.ventura.org/rma/envhealth/hawd.html. You may also scan this code with your mobile
device
.
Please take a moment to provide feedback.
An opinion form can be completed at
http://www.vcrma.org/customer-service-evaluation-form-field-inspection.
You can also find it on our website under Services and
Resources by scanning this QR code:
click to sign
signature
click to edit
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