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12. Mat Is the depth ddept�h�+t-o Cronndwoter". <br />V <br />Describe the source of Information: <br />M& SIt'.4 Uy - C-IUV rr /r "rf-r1/ <br />11. ore there any water wells on this parcel or adjacent properties? YISS 1 I NOX <br />TSTM OF WELLS <br />rablic Well <br />DISTANCK TO TANKSM <br />ft. <br />Private Well <br />tl. <br />irrigation Well <br />ft. <br />Monitoring Well <br />A. <br />Or her <br />[t. <br />14. Will the tunk(s) pending closul'e he replaced with an aboveground or mde[groand storage tank(s)? ME ) N09 <br />I5. Indicate the responsible party to he billed for additional PHS -MID stuff time expended beyond J hour minimum <br />permit payment per lnnk. If the party designated below Is different than the permit applicant, c.g, property owner, <br />the pnrty must ncknimledge this responsibiltry for the billing by signature and date lmlow. <br />IMMU <br />Mniling Address <br />Day phone <br />SUBLUM PMME <br />-7-H <br />Page 6 <br />9-Z.(�'-9y <br />Date <br />