Laserfiche WebLink
« 12..What is the depth towsaW. feet <br /> Dc=*bc the source of information: 41T*n iL�(Yt aIU===dx vreLnAwattr moniuzdne nrtxrrtrn s: <br /> /.ILII ,i <br /> 13. An them any water wells on this parcel or adjacent • - YES [X l NO[ ) <br /> TYPE OF WELLS DISTANCE TO TANK(S <br /> Public Well h• <br /> Private Well h• <br /> bri ation Well fL <br /> Moniuxin Well gmatel 275 ft. <br /> Odxr ovaur ..=ximately 4170 ft. <br /> 14. VLU the tank(s)pwding closure be replaced with An SbOvegrOuDd or MukrgrOuDd=rW tank(s)? <br /> YES [ ] NO [X) <br /> 15. Indicate the msporwible party to be billed for add dotW PHS-EHD staff time expeaW beyond 3 borer minimum permit <br /> payment per task. If the party designated below is differeat than the permit appplicaat.e.g.PlopestY owner.the parry must <br /> his mgmasibility for die billing by gignom and date below- <br /> Name Law=Jj==11.41akulLahmma <br /> Maning Address CA 94550 <br /> Day Phone Number f 510 1423-6572 <br /> S' <br /> gn=M Date6 <br />