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(DRAW TO :SCALE) <br /> ,. SCALE � TO <br /> 1. Names of, streets or roads nearest to or bounding the property. <br /> 2. ©utline. of the property, giving dimensions and .North direction. -g <br /> 3. Dimensioned outlines and locations of all existing and proposed structures,u'iicludi.ng <br /> covered areas such as patios, driveways and walks. <br /> 4: Location of house sewer outlet, public sewer, sewage.-disposal system or proposed sewage, <br /> disposal system, proposed expansion of sewage disposal, system, or any other -possible '.. <br /> 7 .source of contamination. [ 1 - ° ry` r '• , °'-, <br /> 5. Location. of other wells within radius of 75 feet on the property or adjoin*ng property. i <br /> tocati.oni �of sewage,disposa.l system`on`adjo fling property or witAn a radius of, 150 feet.. <br /> lu <br /> -------------- <br /> i' <br /> i ...+.. T 1#� <br /> L <br /> ' r <br /> 7-711 V <br /> It- <br /> 4 e A t r <br /> ..sr N r1b 1979 <br /> T , HIAL N. [S <br />