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A� Is tine depth to groundwater? 40-50 feet <br /> } <br /> �cscribe the source oI InfOrmat9on: Cit of Lodi Wat t <br /> YES NO 1 <br /> Are there any water wells on this parcel or adjacent properties? <br /> i3. <br /> I <br /> UiSTkNCE TO TANI S(S) <br /> TYPE OF WE LLS <br /> Public Well <br /> ft. <br /> Private Well <br /> Irrigation Well <br /> Monitoring Well <br /> Other <br /> iand or nn <br /> Will the tnnk(s) pending closudergronnd storage tdnik(s)? Y>iSE l Not 3 <br /> L4, re be replaced with an bove <br /> agro <br /> he responsible party to be billed for additlonal;PI15-EiID thantheime ermit applicant; g• <br /> propepended beyoiid 3.hour rty owner, <br /> t5, Indicate i Fo <br /> permit payment per tank. It the party designated below„Is <br /> different F <br /> i the party muni acknowledge this responsibility for the billing by signature and date below. <br /> Name <br /> Mailing Address ' ” <br /> Day Phone Number <br /> rr i <br /> Date <br /> Sig ntnr <br /> Page 6 <br /> p • <br />