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' (Draw To Scale)'t <br /> .-SCALE ' TO , <br /> 1. Names of streets or roads nearest to or bounding the property.:,. A <br /> 2. Outline of the property, giving dimensions and North direction' <br /> I Dimensioned outlines and locations of all existing and proposed structures,including covered areas such as patios, <br /> ., driveways and walks. <br /> 4. Location of house sewer outlet, public sewer, sewage disposal system or proposed sewage disposal system, <br /> proposed expansion of sewage disposal system,+.or any other possiblesource of contamination. <br /> 5. Location of other wells within radius-of 150 feet on the property pr adjoining propo�ty:1,—Z <br /> 6. Location of sewage disposal`s'ystein,on adjoining property or within a radius oft150 felt. <br /> `tea <br /> i <br /> - I — — <br /> >\ <br /> i <br /> i <br /> XLI <br /> . \� <br /> r, i <br />