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7-25-1996 d:27PM FROM P. 5 <br /> 12. what is the depth to groundwater? 2^ � <br /> Describe the source of information: �V <br /> Inla,4r.✓ �LS�ulc2 <br /> 13. Are there any water wells on this parcel or adjacent properties'- YES [ j No (/J <br /> TYPE OF WELTS I DISTANCE TO TANU(S) <br /> Public wed 100 R. <br /> Private well 100 ft. <br /> Irrigation well too IL <br /> Monitoring well 100 fL <br /> other lop it. <br /> 14. Will the taalt(s) pending closure be replaced with an abovepvnnd or underground storage tank(s)'. YES[ j NO( I <br /> I5. Indicate the responsible party to be billed for additional PHS-F.TID =9 time "pended beyond 3 hour miaimum <br /> permit payment per tame If the party designated below is different than the permit applicant, e.g. property owner, <br /> the party must acimowledge this responsibility for the billing by signature and date below_ <br /> Name C0kNT--1 e.F SRN <br /> Mailing Address 5'V�e-te-T'p r-� Ca <br /> Day Phone Number 6S— S3s8 <br /> — � <br /> Daa 25 I r1(o <br /> Signa 1 te <br /> Page 6 <br />