ST. JOHNS COUNTY
DEPARTMENT OF BUILDINGS
PERMIT FOR WATER WELL CONSTRUCTION
LOCATION OF JOB:
LICENSE NUMBER: /
WELL USAGE: C lAD SIZE
I hereby consent to be regulated by St. Johns County Environmental
Control Board (Ordinance 76-18) regarding comsumptive use of water
allocation and in accordance with application on file in office of St. Johns
County Health Department. Access to proposed well site for inspection
during construction is hereby granted.
Signature of owner/contractor/or authorized agent
DATE OF APPLICATION: 7 -/-1 -1 ISSUE DATE: 7, -,Ed
FEE: $ .
FEE PAID: $ 7-
St. Johns County Building & Zoning Dept.
P.O. Box 299 St. Austine Fla.
Allen F. Powers, B dingOffi
IOWHNT PRE .Si INC.. ST. AUGU.STINf I A. 060
appropriate puDolc supply is available.
2. Furnish tap (faucet) between:well and pressure tank for
I agree to furnish a log within 30 days of well installation and to comply l -
with all provisions of the rules and regulations of. the St, Johns County
Environmental Control Board, and will notify County. Health Department
twenty-four (24) hours prior to grouting procedure.
L cense Nu ber
I hereby consent to be regulated by St. Johns County Environmental Control
Board regarding consumptive use of water and allocation thereof. Access
to proposed well site for inspection d ung construction is hereby granted.
signature of owner or authorized agent
APPROVED:-_o 4 -
DATE: -1/lf _P _
~~r) ~ (I
' signature of 15rilling Contrattor