*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 you chose #9 above, complete the remaining questions on the form. If not, go to the end of the form and sign.
FEES: For all Drilling and Plugging Applications a $100.00 report deposit is required from the driller at the time of
submittal. If the well report or plugging report is timely submitted to the District, the District will return the report deposit in full.
I certify that, as the Applicant, I am the owner of the well which is the subject of this Application, or the Authorized Agent of the well owner. Additionally, I certify that each and all of the statements and information contained herein are true and correct to the best of my knowledge and belief. Moreover, I agree to fully comply with the terms of the Panola County Groundwater Conservation District’s enabling legislation, the rules of the District, and any water well plugging application requirement that may be requested pursuant to this Application. I understand that failure to comply with the rules of the District and failure to properly plug the water well that is the subject of this Application can result in enforcement by the District.