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12. Whar is the depth to groundwater? __—=S <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELLS DISTANCE TO TANKS(S) <br />Public Well _ ft <br />Other <br />ft. <br />YES f.AYNo [] <br />14. Will the tank(s1,pending closure be replaced with an aboveground or underground storage tank(s)? <br />YES[ ] No <br />15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour <br />minimum permit payment per tank if the party designated below 1s different t`tan the permit <br />applicant, e.g. property owner, the party mast acknowledge this responsibility fong by <br />sfgnature and date below. r the billi <br />Name <br />Mailin <br />Day Phone Number <br />Signature <br />EH 23 046 (Aeriscd 8/9/06) <br />L- <br />' Date <br />9 <br />0 <br />3.-oo tq <br />