Laserfiche WebLink
12. What is the depth to groundwater? <br /> Describe the source of information: l <br /> 13. Are there any water wells on this parcel or adjacent properties? ' /� YES [ ] NO [ ] <br /> TYPE OF WELTS 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 underground storage tank(s)? YES[ ] NO[ ] <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, a g. property owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name ASSOGA-TZS /n)C , <br /> Mailing Address / 37 V2- <br /> Day Phone Number ( 7/y ) �7 3 - 3 K S19/ <br /> 7h�� C <br /> Signature / Date <br /> I�f(J!� .71non) — UreF j��S,t7fiJr.. <br /> Page 6 <br />