Laserfiche WebLink
J / II <br /> 12. What Is the depth to groundwater? K r0u�✓ <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel o .,;Iacent properties? YES (] NO[]� <br /> i <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> a <br /> Public Well tL <br /> Private Well I tL <br /> Irrigation Weil rL <br /> m <br /> onitoring ft <br /> ft. <br /> 14. Will the tank(s)pending closure be replace . .Ath an aboveground or underground storage tank(s)?YES[]NO[] <br /> 15. Indicate the responsible parry to be billea additional PHS-EHD staff time expended beyond 3 hour minimum permit payment <br /> per tank. If the party designated below is 'ferent than the permit applicant,e.g.property owner,the party must acknowledge <br /> this responsibility for the billing by sign a and date below. <br /> Name ZL=B KNAfJ <br /> Ma1DngAddress �' 0 ' 6-t- rI5 Z/ Mad,-5[d 045�3S� <br /> c i <br /> Day Phone Number( <br /> Signature Data <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />