Laserfiche WebLink
i <br /> 12. What is the depth to groundwater? 6 , <br /> Describe the source of Information: <br /> GItFS-E 'r ]2-;MF1W(0n! i'R� SEAT $LaGKS -POWA' THE 5'TK�ti <br /> �d <br /> Tel5- £. I r c <br /> 13. Are there any water wells on this parcel or adjacent properties? <br /> TYPE OF WEUS DISTANCE TO TANKS(S) <br /> Public Well it <br /> Private Well It. <br /> Irrigation Well it. <br /> Monitoring Well It. <br /> Other ft. <br /> 14. Will the tanks)pending closure be replaced with an ahoveground or underground storage tank(s)?YES(]NO< <br /> 15. Indicate the responsible party to be billed for additional PHS•EHD staff time expended beyond 3 hour minimum permit payment <br /> per tank If the party designated below is different than the permit applicant,e.g.property owner,the patty must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Name C 1 T y &,c T,r c y <br /> Mailing Address 54) 1* R�(/(,�ihe i/�� 7& <br /> Day Phone Number( ©� , �3/- yIKV <br /> e8AV <br /> Sign Tide Date <br /> EH 23 046(Revised 10/19/98) Page 6 <br />