Laserfiche WebLink
13. <br />14. <br />15. <br />L J <br />Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />u✓tk <br />Private Well <br />R. 2ft4ft. <br />Irrigation Well <br />f}. <br />Ow <br />Monitoring Well <br />_ <br />Other <br />ft. <br />t) eK <br />YES 'Y NO[ J <br />Will the tank(q) pending closure be replaced with an aboveground or underground storage tank(s)? <br />Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum <br />permit payment per tank. If the party designated below is different titan the permit applicant, e.g. property <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Mailing Address _ t i � 4 . " "" ? _ t <br />1 <br />Day Phone Number C) `�' 0�� <br />Signature Title <br />Eli 23 046 (Revised 12/31/07) 6 <br />8 zI 2008 <br />YES{ I NOX <br />Date <br />