Laserfiche WebLink
12 What u the depth to groundwater? lSfi <br /> Describe the source of lnformatlom <br /> (�T0r Dell � Wir,L�S,r-ei <br /> 13. Are There any water wells on this parcel or adjacent properties? YES NO D}. <br /> TYPE OP WEIIE DISTANCE TO TANKS(S) <br /> Pubbe Well ft <br /> Private Well K <br /> Irrigation Well ft <br /> Monitoring Well h <br /> Other tt <br /> 14. Will the tanks)pending closure be replaced with an aboveground or underground storage tank(s)?YES()NUK <br /> 15. Indicate the responsible parry to be billed for additional PEs-EHD staff time expanded beyond 3 hoar mlaina m permit payment <br /> per tank. If the party designated below is different than the penult applicant e.g.property owner,the party must aclmowledge <br /> Ws responsibility for the billLon by slguatura and date below. <br /> Name S h A vJ Zft V 1/nn ✓ruUIEC -+ I AJGaS Tr�;GTv 2 e— <br /> MaWngAddress U005- 90(2-T Gtc v yta�h ta..t, COnGP1L0 9el520 _ <br /> Day Phone Number( �12.� ) , ofs — 2 1 O 3 ._ <br /> Slgnatwa Title Date <br /> E1423 046(Revised 08/13/99) Page 6 <br /> 12/10/02 TLTE 09: 43 [TX/RX NO 87091 0 010 <br />