Laserfiche WebLink
12. What Is the depth to groundwater? t✓\ ka ,L-aoLA-45 <br /> Describe the source of Informattoa �/ y <br /> LL <br /> 13. Are there any water wells on this parcel or adjacent properties? YES ( ] NO E j� <br /> I <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> i <br /> Pubhc Well It �I <br /> Private Well It. <br /> Irrigation Weil ft <br /> Monitoring Well tL <br /> Other fL <br /> 14. Will the tank(s) pending closure be replaced with as aboveground or underground storage tank(s)? YES( ) NOj ] <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time ezpended beyond 3 hour minimum permit payment <br /> per tank. If the party designated below is different than the permit applIcank e.g. property owner, the party must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Name I Kc-'e' 7F�Rr-: tt <br /> Mailing Address 0 F bQl boo Sc ac Tse _ <br /> i <br /> Day Phone Number ( <br /> / C 3 - 1z - o 1 <br /> Signature OTitle Date <br /> EH 23 046 (Revised 10/ 19/98) Page 6 <br />