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SCALE `�u} A v' 4 <br /> 1. Names of streets or roads nearest to or bountlln , m , <br /> 2. Outline of the property, giving dimensions and th Mt Fi <br /> 3. Dimensioned outlines and locations of allexisting11�„as.. 7..uclures.including covered areas such as patios, <br /> driveways and walks. • yr'1 <br /> 4. Location of house sewer outlet, public sewer + >jj e I system or proposed sewage disposal system, <br /> proposed expansion of sewage disposal system r b+,,,sible Source of contamination. <br /> 5. Location of other wells within radius of 75 feet o °n„ +i or adloleing property. <br /> 6. Location of sewage disposal system on adios.Im p ,par WIM,in a radius of 150 feet. / <br /> t <br /> y tff1 �" • _f....� <br /> \ Vit• . _ <br /> v — <br /> _ I <br /> _ _ J <br /> mss. <br /> r__ I <br /> 7 �' fl �1 � ' • � i <br /> I <br /> P—' <br /> o <br /> l •1 � f ,y; <br /> r <br />