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 represetnative. 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.

A Historic Property Effect Evaluation Form must be submitted with the Non-Production Well application.

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 Other:
Piezometer Inclinometer Dewatering
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/S N/S E/W E/W Section Section Township Range Base Diameter Depth Property
Direction Distance Direction Distance Corner Meridian (inches) (feet) Parcel Number
 
Explanatory :

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