Laserfiche WebLink
12. What is the depth to groundwater? <br />Describe t ource of information: <br />C <br />13. Are there any water wells on this parcel or adjacent properties? YES (] NO <br />TYPE OF WELLS <br />DISTANCE TO TANIGS(S) <br />Public Well <br />--- ft. <br />Private Well <br />ft. <br />Irrigation Well <br />Monitoring Well <br />ft. <br />Other <br />" ft. <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YESK NO( ] <br />15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum <br />permit payment per tank. If the party designated below is different than the permit applicant, a g. property <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />,\/FZNMailing Address i/•� �' <br />Name <br />"/r • i a aI. w 4 <br />Day Phone Number( 510 — " 95� <br />PRS?' n;,e ► ° /®� l� <br />Signature Title _ Date <br />EH 23 046 (Revised 9111/96) Page 6 <br />