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T IJLvVIe P 5a.i ye0et <br />7u x MAP = g ( A Cq-� 3 l; Health Department ? � ( � �� I <br />I Identification Number o <br />Schematic drawing of sewage disposal system and topographic features. PAGE OF <br />Show the lot lines of the building lot and building see, sketch of property showing any topographic features which may impact on the design of the system, all existing and/ <br />or proposed structures including sewage disposal systems and wells within 100 feet of sewage disposal system and reserve area. The schematic drawing of the sewage disposal <br />system shall show sewer lines, pretreatment unit, pump station, conveyance system, and subsurface soil absorption system, reserve area, etc. When a nonpublic drinking water <br />supply is to be located on the same lot show all sources of pollution within 100 feet. <br />❑ The information required above has been drawn on the attached copy of the sketch submitted with the application. <br />Attach additional sheets as necessary to illustrate the design. <br />THOMAS AVENUE �--�` <br />ROUTE # 1208 _� E '_r- -�'-'" EP N <br />N / <br />-EP 7- <br />�Z� o? <br />N N N L= 50.69 N— N 59 P <br />EP <br />R 25.00' R / OVERHEAD ELECTRIC AND --'TELEPHONE _ We;( <br />34.56' _ g� <br />a P - <br />cs0 G W ` \� <br /><p <br />PF PROP.WELe,' \ <br />�EQ <br />49-1" <br />ON <br />Nei b <br />(�I <br />N' <br />PROP. WATER <br />SERVICE L <br />N 1 � <br />45.41 <br />\ V <br />N <br />+ 54 <br />ZOO I <br />wed <br />we .& ar¢ a <br />56 40 , <br />Vj <br />a <br />1 � <br />n /ofd <br />/ . 57 <br />5 30 5 75 <br />1 7 3\ :. <br />K <br />1JI�fti. <br />5 0 <br />" pECK � 56 �. <br />c <br />05 \ \ <br />IPF <br />0 SEWER <br />' \ ER NE LL 3� <br />0 <br />\ <br />CIV <br />P0 rq <br />Sewage Disposal System permits are nontransferable. New owners not listed on page 1 must reapply and pay all applicable fees to reissue <br />permits. <br />