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<br /> (DRAW:TO SCALL)
<br /> ,. =SCALE s "}TO
<br /> a, .r .(1vk 7tr1 �' V �y`�; ce ( y.j%, ! mow— !��
<br /> Name
<br /> 1.' Out' o£ -strreets or roads nearest to or bounding the rod ult xt g�`
<br /> 2. Ou :11nerof they' ro ert property.
<br /> r' P . P y.�='giving dimansions;:and. North"direction'':`i` '
<br /> 3. Aimension-ed outlines and locations. of :
<br /> covered;areas,such,?as ,.patios, driveways and walks.; :;r , x
<br /> g -an& proposed structures, including
<br /> �_4.fip,.Location' of house,'sewer, outlet - ublic sewer 0 1i
<br /> . wdi'eposal,-aye em,- .proposed. expansion.of 'sewage :disposal B stem'` }
<br /> I. , dsewage'di$posal' system orrproposed''sewage'
<br /> '" '
<br /> source of contamination. y , or any otEier poaaible' ;ta"
<br /> 5• Location Oft'othe- r;:wells within radius of.. .x
<br /> 6• Lacatiorn of sewage disposal a stem on et*on the:.prapezty or. Ii.,
<br /> d�oining�'pro ertr
<br /> P y--
<br /> adjoining
<br /> Y } _ Property or withina radius of 100 feet.
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