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£ <br />y <br />t <br />A <br />! <br />■ Hr <br />rrL. <br /><* \ <br />JA'i: <br />^2-j <br />d3v <br />1. <br />2. <br />3. <br />r^K- <br />— <br />7/^ <br />» 1 <br />____ <br />ssi^s-jE <br />-gu^- <br />j^£-—i- <br />a^spit <br />Names of streets or roads nearest to or bounding the property. <br />Outline of the property, giving dimensions and North direction. <br />Dimensioned outlines and locations of all existing and proposed structures, including covered areas such as patios, <br />driveways and walks. <br />4r 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. <br />5. Location of other wells within radius of 75 feet on the property or adjoining property. <br />6. Location of sewage disposal system on adjoining property or within a radius of 150 feet. <br />PLOT PLAN <br />(Draw To Scale) <br />SCALE" TO_