Office use only: □Approved □Denied Date and Initial:_________________
6. Well Data:
*Note that wells equipped to produce 200 gallons per minute or more must provide a Hydrogeological Report meeting the requirements of District Rule 3.17. Applicants required to complete a Hydrogeological Report must publish notice in the newspaper in accordance with District Rule 3.17(c).
If applying for a permit, please fill out the rest of the application, sign, and submit. If not applying for a permit, skip to the end, sign, and submit.