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  • Fl Form Leg-r.040.01 2010

Get Fl Form Leg-r.040.01 2010-2026

St PLEASE FILL OUT ALL APPLICABLE FIELDS Northwest (*Denotes Required Fields Where Applicable) St. Johns River The water well contractor is responsible for completing South Florida this form and forwarding the permit application to the appropriate delegated authority where applicable. Suwannee River DEP Delegated Authority (If Applicable) __________________________ Permit Stipulations Required (See Attached) _ ___________________________________ _ 62-524 Quad No. _______ Delineation No._______.

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How to use or fill out the FL Form LEG-R.040.01 online

Filling out the FL Form LEG-R.040.01 is an essential step in applying for a permit to construct, repair, modify, or abandon a well in Florida. This guide will help you navigate the online process with clarity and ease, ensuring that you provide all necessary information correctly.

Follow the steps to complete the form online.

  1. Press the ‘Get Form’ button to access the FL Form LEG-R.040.01 and open it in your preferred editing tool.
  2. Begin by entering the permit number and the Florida Unique ID in the designated fields at the top of the form. Ensure that all entries are accurate.
  3. Under the 'Owner' section, fill in the legal name (if a corporation), address, city, state, ZIP code, and telephone number of the owner. All fields marked with an asterisk are required.
  4. In the 'Well Location' section, provide the full address, road name or number, and city for the proposed well site.
  5. Complete the 'Parcel ID' field by selecting whether you wish to circle the PIN or Alternate Key, along with the subdivision, section, township, range, and county.
  6. Input the details of the water well contractor, including the contractor's name, license number, telephone number, and their address, ensuring you include any applicable email address.
  7. Indicate the type of work by selecting one of the options: construction, repair, modification, or abandonment. Provide the reason if applicable.
  8. Fill in the number of proposed wells and specify the intended use(s) of the wells from the provided list.
  9. Indicate the distance from the septic system in feet and provide a facility description along with the estimated start date of the project.
  10. Estimate and enter the well depth, casing depth, and primary casing diameter. Include details on the open hole and screen interval.
  11. Select the primary casing material and secondary casing details, including materials and diameters.
  12. Describe the method of construction, repair, or abandonment by checking all applicable methods.
  13. Complete the grouting interval information and indicate the total number of existing wells on site.
  14. Answer whether the well or any existing water withdrawal is covered under a Consumptive/Water Use Permit and provide the required numbers if applicable.
  15. Fill in the latitude and longitude of the well location. State the data source and datum used.
  16. Review all the certifications and ensure all required signatures from both the contractor and property owner or their agent are included.
  17. Once you have filled out all the necessary fields, save your changes, and download or print the form for submission.

Start filling out your FL Form LEG-R.040.01 online today to ensure your well permit application is processed efficiently.

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FORM LEG-R.040.01 (6/10) This permit is valid for 90 days from the date of issue. Rule...
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