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11. <br />13. <br />14. <br />1:. <br />.� <br />45 feet <br />What is the depth to groundwater' information <br />Describe the source of information: Flood <br />County <br />ells on this parcel or adjacent Properties? <br />Are [here any w'ater w <br />TYPE OF WELLS I DISTANCE TO TANKS(S) <br />Public Well I <br />750 <br />ft. <br />Private Well <br />NA <br />ft. <br />irrigation Well <br />NA <br />ft. <br />.Monitoring Well I <br />2, 500 <br />ft' <br />Other <br />NA <br />fc <br />YES ll NO$1 <br />will the tank(s) pending closure be replaced with an aboveground or andergro <br />and stooge tank(s)? YESI 1 NOIXIX <br />ended beyond 3 hour minimum <br />it applicant, e.g. Property <br />Indicate the responsible part' to be billed for additional PHS-EHD staff time <br />permit payment per tank. If the Pam' iffrent than the perna <br />desigonsibilnated bity for the billing by Sigelow is d narure and dace below. <br />owner, the part' must acknowledge this resp <br />Name L, —- <br />5457 Covey Creek Circle <br />♦failing Address <br />Day Phone Number <br />2(� 473 — 0501 <br />Title <br />Signatuv <br />EH 23 046 (Revised 9111196) <br />page 6 <br />Stockton Ca95207 <br />Ljl zf <br />Date <br />