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"LOT nLAN <br /> (DRAW TO SCALE) <br /> SCALE " TO ' <br /> r.l. Names of streets or roads nearest to or bounding the property. <br /> 2. Outline of the property, giving dimensions and North direction. <br /> 3. Dimensioned outlines and locations of all existing and proposed structures, including <br /> r covered areas such as patios, driveways and walks. <br /> 4 . Location of house sewer outlet, public sewer, sewage disposal system or proposed sewage <br /> disposal system, proposed expansion of sewage disposal system, or any other possible <br /> source of contamination. <br /> 5. Location of other wells within radius of 75 feet on the property or adjoining property. <br /> 5. Location of sewage disposal system on adjoining property or within a radius of 150 feet. <br /> r <br /> ----------- <br /> I <br /> i <br /> j <br /> y q <br /> i <br /> i <br /> ' .. ...... ......' . <br />