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OT1PLANt't ,V~•+ �'",, '-" r""-ti f�� +ai .v'..•,_;'�y t�?v', 's-:.i.>rs �7'.s:.; <br /> lrishA1 <br /> ii i �+t A ,st'�et <br /> 7 y �« �;+1�''r'• la�il�.;y+ 'i� e.'tt,fit sC`.�-2v+'r 'GSM �' "!=ai•-k Kll,.t�,� �'Pyc� ''w.. '" # /�}, rr <br /> t . 'f- ``;_,•"�.� -�C,atYE is { To�1 .:��; saY�r:"r����t` � . <br /> 11 f. • tju+T.4 ��� 3- ^C a e 4it x .e ',�..} <br /> Names of streets or roads nearest to'or bounding the <br /> _property.r_�`,,h > r•} <s ,� i t ,,,� <br /> utline of the property. giving dimensions�,and North direction ,,,,r ^t r* �s�^ ``s` �= �`�. ' ' a PO+ <br /> Imensioned outlines and locations of allexistfng and pro posed structures,Including covered as such aslpat�os <br /> driveways and walks. Y <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 possible source of contamination a a <br /> S. Location of other wells within radius of 150 feet on the property or adjoining property. <br /> B Location of sewage disposal system on adjoining property or within a radius of 150 feet. <br /> t ! <br /> I � <br /> a 4J. <br /> C3 <br /> fT <br /> UTi &o <br /> _ ~ <br /> # a <br /> g a <br /> a <br /> r <br /> _ r <br /> .r <br /> M ` <br /> Y <br />