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lt. What Is lite depth to groundwater? _ Q <br /> rJ � <br /> Describe theInror allo <br /> soV�rce o/� <br /> 1 z We,"fe' k �R tJ11 PR l <br /> 13. Are there nny water wells on this parcel or ad)ncenl properties? YFS O NO <br /> TYPF, Oy WF,US I)MrANCF,TO TANKS(S) <br /> Public Well n. <br /> Private Well n• <br /> Irrignllan Well n. <br /> Monitoring Well It. <br /> Other n. <br /> 14. Will file lnnk(s) pending closure be repinced with an abowegrovnd or underground storage lank(s)? YES( ( NO( ) <br /> 15. lndlente the responsible party to be billed rot nddnlounl PIIS-Gill) stnR time expended beyond 3 hour minimum <br /> permit payment per tank. If the pnrty desIgunted below Is different than the permit applicant, e.g. property owner, <br /> the pnrly mus( acknowledge this responsibility rot the billing by signature and date below. <br /> n <br /> Name S a VXS <br /> hlnllimt Address1 <br /> Day Phone Number ( U�) `!(eb 6735 <br /> ron, <br /> a Dale <br /> Page 6 <br />