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PLO r PAN <br /> (Draw To Scale) <br /> i(,AiJ TO <br /> 1 �tr1111, ,tt •.111', t:r ,, Il ! f'. .1,•" , • (lf t111�111111f111 the prf"Pt rte <br /> .' Outil:l: rt thr• ptol 1•rty fl.. !„nl:n ,lclnc. xid North cfl+e(;tlon <br /> 3 Dnmonsuonod oath Ios;+rld 1„1 1'. .r,s( , + I Int I:tlnll and propnserf structures,including coverc!d arra•;quch as patios, <br /> dfiveways and w.Ik%. <br /> d L(,callon cot hour•' f w + "WI, r I,uhilC !1ow,2r, sewacte disposal system or proposed sewage disposal system, <br /> propose,: I�xpanvto.l of :e.'.,1 11- sy:,tem, or any other poss:5le source of contamination. <br /> 5 Location of other wells within radius of 150 feet on the property or adjoining property. <br /> G Location of sewage disposal system on adjoining property or within a radius of 150 !pet <br /> f- T y 1 I <br /> i <br /> 1 <br /> I I 1 <br /> , 1 I <br /> ill Imill ' <br /> i <br /> Yv <br /> IN I <br /> IV <br /> FT <br /> 1. <br /> i <br /> I <br /> l 1 ! <br /> I <br /> 1 <br /> j I <br /> -i.-•r— '-ITS--J I <br />