Laserfiche WebLink
12. What is the depth to groundwater? . 6 C-5 <br />C Rau, 1)tlATc1? a /l�a/?DYj�9'4TtV /0 <br />Describe the spurce of information: <br />13. Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELLS I <br />DISTANCE TO TANICS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />R• <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />2ec <br />YES ( ] NOA <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NOIX <br />15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum <br />permit payment per tank. If the party designated below is different than the permit applicant, e.g. property owner, <br />the party must acknowledge this responsibility for the billing by signature and date below. <br />Name 7— F <br />C- ?Y <br />OF <br />MAC V <br />i1T7-nl ` 1019VL- <br />IJEKMI9 <br />Mailing Address <br />SZD <br />TAAC �� <br />71?.4CV CA <br />1) 5�)1 <br />Day Phone Number ( Z.O`l ) g.� 6 — /W o <br />Signature <br />Pugs 6 <br />Date <br />