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13. Are there any water wells on this parcel or adjacent properties? YES [I NOX <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well / ft. <br /> Private Well ft. <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)? YES[]N� <br /> 15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum <br /> permit payment per tank. If the party designated below is different than the permit applicant,e.g.property <br /> owner,the party must acknowledge this responsibility four the)billing by signature and date below. ) <br /> Name <br /> Mailing Address �� �'. W�'6�� Adf 327 Aee&e 57e- Ck7o„-)C9. 95'zoz <br /> Day Phone Number( �2-O 7 ) ? 7 fs_3 7 <br /> �rc;eCA i-c\;' � <br /> SWUM itle Date ' <br /> EH 23 046 (Revised 12/31/07) <br />