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l2. What u the depth to groundwater? <br />Describe the source of information. <br />ur, <br />13. ere there any water wells on this parcel or adjacent properties? <br />YES J NO <br />14- Will the lank(s) pending claaura be replaced with an abovegrotwd or uader9musid storage tank(s)? YLS1 . <br />15. Indicate the responsible parry to be billed fur additional PHS-EHD staff time espeaded beyond 3 Dour mu,; <br />permit payment per taoL If the party deotgnattd below it different than the permit applicant. e.g. proper <br />owner. the party must acknowledge this rnp6111ibliity for the billing by signature and dale below. <br />Name <br />Msllin <br />nay Phone Namber Cil 1 ) / hk%— S'; .—.-.—..- .. <br />mate <br />EH 23 046 (Revised 9/11/96) Pago 6 <br />DISTANCE TU TANIfS(blic <br />PE OR WELT S <br />Wen <br />F <br />It. <br />vate Well <br />le. <br />Irrigation Well <br />st• <br />Monitoring Well <br />ft. <br />Other <br />ft - <br />YES J NO <br />14- Will the lank(s) pending claaura be replaced with an abovegrotwd or uader9musid storage tank(s)? YLS1 . <br />15. Indicate the responsible parry to be billed fur additional PHS-EHD staff time espeaded beyond 3 Dour mu,; <br />permit payment per taoL If the party deotgnattd below it different than the permit applicant. e.g. proper <br />owner. the party must acknowledge this rnp6111ibliity for the billing by signature and dale below. <br />Name <br />Msllin <br />nay Phone Namber Cil 1 ) / hk%— S'; .—.-.—..- .. <br />mate <br />EH 23 046 (Revised 9/11/96) Pago 6 <br />