REQUEST FOR NON-PRODUCTION WELL CONSTRUCTION
Fill out this form, and then click the button to generate the printable form, then print the Non-Production Well Construction form from the resulting .pdf file. If you would like to print a blank Non-Production Well Construction form, simply leave the form blank and click the button to generate the printable Non-Production Well Construction form.

- The Non-Production Well Form must be completed and signed by the project owner or authorized representative. The form shall not be signed by the licensed driller.

- See R655-4-9 of the Administrative Rules for Water Wells for information and requirements for the approval process for non-production wells.

- See R655-4-12 and R655-4-15 of the Administrative Rules for Water Wells for drilling and construction information and regulations for non-production wells.

This permit may not be the only authorization needed to drill a well. The applicant is responsible for obtaining other permits/authorizations from federal agencies, other state agencies, and/or local jurisdictions as applicable. Moreover, if the applicant is not the landowner, it is the applicant's responsibility to ensure that approvals/permissions have been obtained to trespass and drill a well(s) on the property. This permit does not give authorization to trespass on private property.

The Adobe reader is required to print the Non-Production Well Construction form. It can be acquired at the following link.

 
   
 
 
Well Type :
Provisional    (if checked, provide Water Right / Application Number : )
Test    Monitor    Cathodic Protection    Closed Loop Heat Exchange
Piezometer    Inclinometer    Dewatering    Other:
Applicant's Name :
   
Mailing Address :
   
   
   
Project Address :
   
   
   
Contact Person : Phone :
       
Proposed Start Date : Anticipated Completion Date :
       
Well Driller's License Number : Proposed Number of Wells :
       
 
PROPOSE LOCATION OF WELLS:County : Water Right Area :
      
N/SN/SE/WE/WSectionSectionTownshipRangeBaseDiameterDepthProperty
DirectionDistanceDirectionDistanceCornerMeridian(inches)(feet)Parcel Number
Explanatory :