Environmental Management Department
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ENVIRONMENTAL MANAGEMENT DEPARTMENT ENVIRONMENTAL COMPLIANCE DIVISION 10590 ARMSTRONG AVENUE, SUITE A MATHER CA 95655 (916) 875-8400
ENVIRONMENTAL COMPLIANCE SITE PLAN FOR WELL AND SEWAGE DISPOSAL SYSTEM PERMITS
STREET ADDRESS: DATE: OR PARCEL NUMBER: AND STREET NAME: CENSUS TRACT: CONTRACTOR: PERMIT #:
SHOW PARCEL DIMENSIONS, STREETS, STRUCTURES, CONTOURS, LOCATION OF WELLS AND SEPTIC SYSTEMS (SHOW LAYOUT OF SEPTIC SYSTEM). SHOW DISTANCE (IN FEET) FROM SEPTIC AND/OR WELL TO: WATER COURSES, SEPTIC TANKS, LEACHING AREAS, PROPERTY LINES, SEWER LINES AND WATER WELLS (ALSO WELLS AND SEPTIC SYSTEMS WITHIN SETBACK DISTANCES ON ADJACENT PROPERTY). SITE PLAN MUST BE ACCURATE TO ALLOW SYSTEM OR WELL TO BE LOCATED AT A FUTURE DATE.
WILL SYSTEM OR WELL BE INSTALLED IN 100 YEAR FLOODPLAIN? YES NO N
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