HomeMy WebLinkAboutWater Well PermitsSTATE OF FLORIDA PERMtVAPPLICKfICIN TO copjWrRuCT,
IIEPAIR, MODIFY, OIWANDoim AWELL Pornlit No.
O'Southwest riaklij Unique ID__.--
- A4 PLEASE r1u, 001 ALL. APPU ASIX FIELDS
L i Northmst ('Donolo.%,RoqUirLd,piel�.'s,WhereApplicat)le) i7ornilt &1jula6ans Roquirod (Soo Attached)
C St. Johns Rivoi*
n South' Florida VW -"f rjou ewpolway
62424'QUad No.tepp
No.C1 Suwannee River
ODEP
("I M I & A PUPiWUP Application No__
Da Qua U Abuloray kir,
WIM"Y T
I,cn OF, 'Santa —
ZIP frl o Fh
Z D .01 1
'Well Locationdare R 0 I Nam 'Nurnhipr Clt
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3, "
arceillu u, (PI or ernate coy Ono)
00 kwBfbckUni
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19 ctlon oor�L^and Grant ;�rc T, -Stibdivirlon Check If 02-974; Yes � No
Vate" Well Contractor
8, 'Number of Proposed Wells
0. 'Specify Intended Uso(s) of Well(s):
$-.041noslic _Landscape Irrigai
Botlled Water Supply _Roqreallcin Area I
_-,Public Water Supply (Limited Uae/DOH)
—Public Water Supply (Community or Non-Comint,
—Clasti I Inloollon
Class V Injection: __Recharge Commerciallinj
Remadiation: Sparge
lVDIstence Imin Septic S ystornlf:S�O�It
IvEstiritatail-V tRak tFAtirneitodca6ii
14. Estimated Screen Interval: From To
15.,primary Casino Matetial: -...Black Steal
16. Secondary Casing: TXtiauscapo Casing
I?. Secondary Casing Material. Slack stoat
10.*Mothad of Construction, Repair, or Abandonment:!
Combinatlbn (Two or More Methods)
--l-loftontbi Drilling -_Plugged by
19. Propose Grouting t rval for (he Primary, Seconi
From _To Seat Malefial Bete
From Tq- Sea) -Material
From_ --Tq—Seat all
Froln_Tq_3eal Material 'en
20, Indicate total number ofegslIn .q, welts' on site.
21.1 Is this well or any existing well or water withdrawall
or CUPANUP Application? ______Yes _-No
22. LaUludo- Inn Itudi
23. Diiti Obtained From: ---GPS MapX - map
rovid
Palo Stamp
W 1��t AoriculluraHrrigution
I I ,—Sile Investigation
ii at, on --.Live slnck Monitoring
Nursery Irrigation -rest
Commerciallindustrial
0� 'mrp) Geothermal
Golf (Xitirso Irrigation __HVAC Supply
_HVA(' , Ratuni
Iul rill Disposal Aquifer Storage and ReCOvefy . _..._.Drainage
0111101at usa only
citit D"porlp!Ion_::= 12, 5timated Start Date
i "Primary Couirlfl.Diameter in. Open Hole: Frofk
19 G.1vilniod VC Steel
I li , -
that-.
surfa'asing ce C Dlatnetor_ in.
GalviiiiZud --- PVC SIa1n6ss Steel Other
LAiLiD
ar ,_Cable7bol _Je.
tted ___Sonlc
A I JK�,Iary
QTVJ Driven (Well Point, Sand Point) --ji-lydraulic Point (Direct Push)
0 Poothod Ocher tLlmwoL__
iii j�DdAdditional CMInfl:
" lti N6at celi'vinL—Plher
to W Neat cernanlL
to W Near Ceffiant0flier
List numbGrofoxisting unusod wella on situ
inl owner's contiguous property covered under a ConsuniptivDJWater Use Potmit (CUPIWUP)
11=010to the following: CUPNVUP No._._..._,_ District Well ID No.
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a y
y Datum: _NA027 _NAD83 _WGS84
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Cxplrutwa DatQ
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14ORIZED OFFICER OR REPRESENTATIVE OFTlir wmi) ORI)ELEGATEDAUT14ORITY, -niE
NSTRUCTIOW, REPAIR, MODIFICAYION.,014 AGANDONMPENT ACTIVITIES.
,fiV4 Dalw OrAtibar:1, 2010 pno 1 of 2