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(Draw To Scale) u <br /> SCALE " TO <br /> 1.. Names of streets or roads nearest to or bounding the property: <br /> 2. 'Outline:bf the property, giving dimensions and North direction: " <br /> I Dimensioned outlines`and locations of all existing and proposed structures,including covered areas such as'patios, <br /> driveways and walks. <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 /> I <br /> r f <br /> p.s <br /> J 1'I I <br /> l ; <br /> l <br /> f _ <br />