Laserfiche WebLink
12. What is the depth to groundwater? /(? 17r-- ( '� <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [] N4 <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tanks) pending closure be replaced with an aboveground or underground storage tank(s)? <br /> YES[]NO <br /> 15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour <br /> minimum permit payment per tank. If the party designated below is different than the permit <br /> applicant, e.g. property owner, the party must acknowledge this responsibility for the billing by <br /> signature and date below. <br /> Name 2)eV 7'7� dL L. t'.L i0 <br /> Mailing Address `� Cr, �O it /ham 7-5 <br /> 'Signature Title Date <br /> E112-3046 (Revised 1!/2!/06) <br />