Laserfiche WebLink
12. What is the depth to groundwater? <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO <br /> TYPE OF WELIS 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 tank(s) pending closure be replaced with an aboveground or deigroun storage tank(s)? YESp(1 NO[ 1 <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 /> N <br /> Name rmm � .r_LernP/Ir ([�, / � �[ p�-�7 <br /> Mailing Address 3750 1wU urN �(uh *A . �RCtOrf%Cn4p 07 1 5Q 1 <br /> Day Phone Number c 9l6 ) 489722 z <br /> Id/�t�g 4 <br /> Signature Date <br /> Page 6 <br />