APPLICATION FOR WELL CONSTRUCTION/REGISTRATION
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New Well Existing Well Re-work Replace Re-equip Name of Landowner Name & Address of Agent if applicable MailingAddress City, Zip Home Phone Wk/Cell Phone Fax Driller Aquifer* Latitude/Longitude Location of Well: CR / PR / Hwy 911 Address Name of Subdivision Lot#Blk # Well Use: Domestic Livestock Other Depth of well Diameter of Casing Pump Size Distance of well from nearest intersecting property line (Min. 50 ft.) Distance of well from septic system (Min. 100 ft.) Number of acres Describe other existing wells located on property Is well located in the Edwards Aquifer Recharge Zone? Yes No If yes, contact the Edwards Aquifer Authority for appropriate permit. *NOTE: PERMIT NOT VALID FOR WELLS COMPLETED IN THE EDWARDS AQUIFER. Signature of Landowner or Agent MCGWD General Manager Dated: Ten Dollars ($10) Registration: Check # Cash APPLICATION FOR WELL CONSTRUCTION/REGISTRATION EXEMPT WELLS http://www.medinagwcd.org
Transcript of APPLICATION FOR WELL CONSTRUCTION/REGISTRATION
New Well Existing Well Re-work Replace Re-equip
Name of Landowner
Name & Address of Agent if applicable
MailingAddress City, Zip
Home Phone Wk/Cell Phone Fax
Driller Aquifer* Latitude/Longitude
Location of Well: CR / PR / Hwy 911 Address
Name of Subdivision Lot#Blk #
Well Use: Domestic Livestock Other
Depth of well Diameter of Casing Pump Size
Distance of well from nearest intersecting property line (Min. 50 ft.)
Distance of well from septic system (Min. 100 ft.) Number of acres
Describe other existing wells located on property
Is well located in the Edwards Aquifer Recharge Zone? Yes NoIf yes, contact the Edwards Aquifer Authority for appropriate permit.*NOTE: PERMIT NOT VALID FOR WELLS COMPLETED IN THE EDWARDS AQUIFER.
Signature of Landowner or Agent MCGWD General Manager Dated:
Ten Dollars ($10) Registration: Check # Cash
APPLICATION FOR WELL CONSTRUCTION/REGISTRATIONEXEMPT WELLS
http://www.medinagwcd.org
