Laserfiche WebLink
12. What is the depth to groundwater? fi 1-71PIL /-/ C . <br />Describe the source of <br />13. Are there any water wells on this parcel or adjacent properties? <br />YES [ ] NO []- <br />TYPE OF WENS <br />DISTANCE TO TANKS(S) <br />ft. <br />ft. <br />7Well <br />R• <br />ft. <br />)( ft. <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES( ] NO[q] <br />h. Indicate the responsible party to be billed for additional PIIS-ERD 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 />Mailing Address t C) QC) � �c��E�� \ 1 � l5 (r I ae9 Gk, CIS Ji -L <br />Day Phone Number ( Z09 ) 3c- 7 <br />Sigtta re Date' <br />Page 6 <br />