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ly_ Whnt is t <br />Describe the <br />13. <br />10. <br />1s. <br />to gmundwat", <br />of <br />,ire there any waWr wells on this parcel or adl=nt Properties'. <br />TYPE OF WFf.f G 1 DI.MNC£ TO TANKS(S) <br />public W01 <br />(L <br />Private Wetl <br />Irrigation Well <br />�^ <br />Monitoring Well <br />Ai .0 ft. <br />- -ft <br />Other <br />YES )0 ,40 [I <br />pViEi the tank(s) pending closurE be reply <br />rPd with an I abovcgrotmd or n.derWa.0d storage mnk(s)'. `IFS{ I Nox <br />tudicate the responsible party to be billed for additional M'EUD staff tin= expended beyond 3 bout minimum <br />permit payment per rank. If the party designated below is different than the permit applicant, e.g. property owner, <br />the putty must acknowledge this responsibility for the billing by signature and date below. <br />Marling Address <br />Day Phone Number <br />r <br />3iynu[u[e <br />1 -/YNWI <br />Date <br />