Laserfiche WebLink
12. <br />13 <br />What is the depth to groundwater? <br />Describe the source of information: <br />Are there any water wells on this parcel or adjacent properties? <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />E <br />YES [] NO K <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, e.g. property <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name A-11 Leto i L% o tj cl <br />Mailing Address I Z Z LIQ L-c)c je-t--O,- 7;, <br />Day Phone Number70 q <br />SigAat*ure Qle <br />EH 23 046 (Revised 7/10/96) Page 6 <br />Date <br />