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Well Permit Application

  1. Required Information

    Note: Incomplete applications cannot be processed.

  2. Well Construction Information for Proposed Well

  3. Purpose*

  4. Well Location Information for Existing Wells

    List all existing wells on owner's contiguous property.

  5. In Use?

  6. Please list any other known existing wells on the owner's property or neighboring properties.

  7. Submit this application with a plat map/aerial photo (with location of listed wells clearly marked). A non-refundable fee of $300 must be submitted to the county at the pre-site inspection or by mail.

  8. Certification of Application

    I Certify that I am not applying for a permit to construct a Public Water Supply well and that all information listed above is correct to the best of my knowledge. I have listed all existing wells. Any well not in use must be sealed as standby wells or property plugged within 90 days and DNR form 542-1226 filed with the Department of Natural Resources and the county.

  9. Leave This Blank:

  10. This field is not part of the form submission.