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4, <br />*— <br />£x <br />It <br />4 <br />. <br />Ii <br />r <br />•j z> <br />< <br /><•{] <br />5. <br />6. <br />1. <br />2. <br />3. <br />Names of streets or roads nearest to or bounding the property. <br />Outline of the property, giving dimensions and North direction. <br />Dimensioned outlinesand locations of all existing and proposed structures, including covered areas such as patios, <br />driveways and walks. <br />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 />Location of other wells within radius of 75 feet on the property or adjoining property. <br />Location of sewage disposal system on adjoining property or within a radius of 150 feet. <br />I— <br />PLOT PLAN <br />(Draw To Scale) <br />SCALE” TO_ <br />J- <br />i7^---- <br />jt-pf - <br />“I------------------ <br />■ 4^u6-4- <br />-