Laserfiche WebLink
12. What Is the depth to groundwater? <br /> Describe the source of Information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ NO <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well M <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YE' 10 NO[ <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minhnum permit payment <br /> per tank. If the party designated below Is different than the permit applicant e.g.property owner,the party must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Name I&F 9F- <br /> Mailing Address .17 <br /> Day Phone Number f 17169 <br /> /46 <br /> Si!- atur;�k Title Date <br /> EH 23 046(Revised 08/13/99) Page 6 <br />