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11- <br />13. <br />11. <br />What is the depth to groundwater" f�� ti <br />G�Gu \ <br />Describe the source of information: <br />Are there any water wells on this parcel or adjacent properties' <br />FTYPE OF WEU.S <br />DISTANCE TO TANKS(S) <br />Public Well <br />it. <br />Private Well <br />ft <br />Irrigation Well <br />ft <br />Monitoring Well <br />ft <br />Other <br />ft - <br />YES [ ] NO <br />Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NOV <br />15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum <br />permit payment per mnk. If the party designated below is different than the permit applicant, e.g. property owner, <br />the patty must acknowledge this responsibility for the billing by signature and date below. <br />InI <br />Name <br />Mailing Address <br />Day Phone Number <br />Page 6 <br />Z <br />Date <br />