Laserfiche WebLink
12. What is the depth to groundwater? <br /> — S <br /> Describe the source of information: <br /> <JV"4to. VtAt 2" G tL� - EL-OCI7 e� lz^ f�[A�S t�Lr 19`15 <br /> 13. Are there any water wells on this parcel or adjacent properties? �,[tiKVL...�t( YES [ ] NO [ ] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well it <br /> Private Well it. <br /> Irrigation Well ft. <br /> Monitoring Well It. <br /> Other it. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground runderground s orage tank^. YESt�NO[ ] <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum <br /> permit payment per tank If the party designated below is different than the permit applicant, e.g. property owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name rr 11.15Fi A 6644(' <br /> Mailing Address <br /> Day Phone Number ( ) <br /> Signature Date <br /> Page 6 <br />