Laserfiche WebLink
M What Is the depth to groundwater? On <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [] NO[] <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[]NO[] <br /> 15. Indicate the responsible party to be baled for additional PHS-EHD staff time expended beyond 3 hour minimum permit payment <br /> per tank. If the party designated below Is different than the permit applicant,e.g.property owner,the party mast acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Name �`�- � — : � K����JC\Q ,S -Q- <br /> Mailing Address lb?)D Ito ,ovo..C��5��1 <br /> Day Phone Number <br /> Signature Title Date <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />