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Get MN Well Sealing Permit Application 2014

N OF WELL LOCATION: TOWNSHIP RANGE WELL SEALING PERMIT APPLICATION Office Use Only Attach a site map showing well location(s). Identify property lines, buildings, roads, intersections, and other structures. Reference distances from the nearest landmark. SECTION QUARTERS SMALLEST LARGEST N W ¼ ¼ ¼ ¼ N W ¼ ¼ ¼ ¼ N W ¼ ¼ ¼ ¼ WELL ADDRESS SITE NAME USE / TYPE OF WELL: Check one of following: WELL HEAD FINISH: WELL CONDITION: Submit a sealing plan if you answer .

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