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Walton Eneineerina 9163731172 P.02 <br />12. what Is the depth to groundwater' g5o <br />Describe the source of information: <br />— S4, -J ..SOACtvl,J <br />13. Are there any welter wells on this parcel or adjacent properties? <br />Public Well <br />ft. <br />Private Well <br />ft <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft <br />Other <br />r� <br />YE5 t l Na D4 <br />14. Will the tank(s) pending closure be replaced with an abovegrowidl �torage taWs)? YESH/r,01 j <br />13. Indicate the responsible party to he billed for additional PHS-ERD staff time expended beyond 3 hour mintmam <br />permit payment per tank If the party designated below is different then the p.m it appllcant, e.g. property <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name <br />C.yw- Vz-e <br />MA1x.ErS, <br />!i'J<_ , <br />Mailing Address X50 <br />gPs"rMeO-(5&v <br />i5pT�Z-Ma�Ct <br />4 $395 <br />Day Phone Number f�l ) (c "7 1,6S JO <br />r 0 <br />M" icP7" &rN6f- ZeVc. rY� <br />stere'� ^' <br />Title Date <br />T1,11 -7 Z7 <br />Owner Signature r <br />RH 23 046 (Revised V UY96) pap 6 <br />