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(Draw To Scale) <br /> SCALE " TO ' <br /> / 0 P�- <br /> 1. Names of streets or roads nearest to or bounding the property. �n W -�� , , <br /> 2, Outline of the property, giving dimensions and North direction. S lru l� <br /> -- 3, Dimensioned outlines and locations of all existing and proposed structures, <br /> driveways and walks. including coverea <br /> d arssuch as patios, <br /> 3 f <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. <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 /> t <br /> 3 r Y 1F <br /> 1, Y <br /> 16 V <br /> 111 t 6 <br /> L� <br /> _FF <br /> i t F i <br /> # � u <br /> V <br /> r <br /> f <br /> 9 <br /> Fj <br /> �� -J U 00 1 CLL C� v <br />