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12. What is the depth to groundwater? - nor v(ijQ W, Wi N r–IM 7 E ,�.r <br /> Desai-be the source of information: pthf0 W ia� 4 �( C d"{d 1s1K I3 <br /> L a Are`zeta arry watt wells on this parcel or adjacent properties? YES NO(j <br /> TYM OF WELLS DISTANCE TO TANX$(S) J— <br /> W"e— 1j <br /> Pub&c WeII M gD� ft <br /> Private Well ft <br /> 4tiJ z��- <br /> Irrigation Well ft. <br /> MonitoringWell ft. <br /> Othez ft. <br /> 14 Will the tank(c)pending dtosure be replaced with an aboveground or underground storage <br /> tank:(.>)?YFS(j NOX <br /> 1$_ ftnd"MRtp i;"e responsible party to be billed for additional EHD staff time expended beyond 3 hour mini=.nuun <br /> pe Ldt pay�cwt per tank- If the party designated below is different than the permit applicant,mg.prepe:ty <br /> or+ner,the party <br /> �ymust <br /> taacknowledge <br /> .t ds responsibility for the billing by signature and,d/aa to below, <br /> MailmAddress �3 �� LfNflfj�f SI`12E�r ` st`73Cb l�i�( 7610 <br /> Day Phone Number(. 2. tq ) `j Q Z t 6 Z1— <br /> sphTe Title Date <br /> EH 23 tido(R 4sd10li6103) Page 6 <br />