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12. What is the depth to gro"O mwT <br /> Describe the source of kdormaOM <br /> 13. Are there auy water w4b oit this Pascal or 04449Mt PMPerties? YFS [ ] No <br /> TYPE of WSi18 DYSTANCB To TANSSM <br /> Pubue well <br /> Private WeU <br /> Irrigation well <br /> i` Mouttoru g well M <br /> other �- <br /> E <br /> 14. Will the tank(s) pending dosure be replaced with as aboveground or uadeqftuand storage tank(s)? YES <br /> 15. indicate the responsible patty to be billed for additloual PHS-EHD staff time expended beyond 3 hour uAnhouai <br /> permit payment. <br />!� <br /> NameU�D <br /> Mailing Address ALLT - <br /> 1 <br /> Day Phone Number { ZD ) 1$ - <br /> i <br /> f <br /> Page¢ <br />