Laserfiche WebLink
12. What is the depth to groundwater? <br />13. <br />14. <br />Describe the source of information: <br />Are there any water wells on this parcel or adjacent properties? <br />YES [ ] NO bQ <br />TYPE OF WEI IS DLSTANCE TO TANKS(S) <br />Public Well <br />ft- <br />Private Well <br />M <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft' <br />Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)'. YES[ ] NOW <br />15. Indicate the responsible party to be billed for additional PHS-EHD staff time permit <br />dppbeyond 3bhourr minimum er <br />permit payment per tank. If the party designated below is different than the ermit applicant, e. property <br />the party must acknowledge this responsibility for the billing by signature and date below. <br />Name -*I Z, <br />Mailing Address Zt? S'0 <br />Day Phone Number ( r11 e ) L, '�3 G "-2 ti LA - <br />Signature <br />Page 6 <br />-1 — 1 <br />Date <br />