|
Upon completion, mail your application to:
Anaheim Public Utilities
Attn: Marie Newland
Environmental Services
201 S. Anaheim Blvd. #601
Anaheim, CA 92805
The permit is not valid until signed by the City’s Authorizing Agent and a permit number is assigned. All accompanying documentation and payment with a check, made payable to the City of Anaheim, must be included with each application. Allow five business days for processing. Any questions you may have regarding Anaheim Public Utilities Well Permit Program should be directed to Marie Newland (714.765.4166) or Dick Wilson (714.765.4277).
A well permit is valid for no more than six months after issuance.
All fields in the application must be completed as follows:
1. Type of Permit: Check construction or destruction. If both are to be conducted, separate permits for construction and destruction are to be submitted.
2. Date: The date the application is submitted.
3. Location of Well: Include a site specific address where available. If not available, list applicable cross-streets and approximate site address.
4. Applicant’s Name, Company, Address, City, State, Zip Code and Phone: The person completing the application is to fill out this information as the applicant.
5. Open UST cleanup case: Check the corresponding box, yes or no.
6. Location Map: In the space provided, draw the nearest cross-streets and identify location of well(s) to be drilled. Submit two copies of a site plan that shows the location(s) of the proposed well(s). If existing wells are present on the site, these wells are also to be included on the site plan.
7. 48-hour notification: Applicant shall notify the City at least 48 hours prior to conducting field activities.
8. Applicant’s Signature/Date: Applicant must be authorized to sign on behalf of property owner or well owner and agrees to comply with applicable well construction/destruction standards.
9. Inspected By/Date: To be completed by the City.
10. Well Owner: This needs to be an individual’s name, either the well owner or representative of the well owner, but not a company name.
11. Company, Address, City, State, Zip Code and Phone: This information is to be completed as it relates to the well owner.
12. Proposed Well(s): List the number of wells proposed to be constructed or destroyed.
13. Well ID: This represents a unique well identification number for each well. For example, MW-6 or VM-13.
14. Type: Specify the type of well that is to be constructed or destroyed such as: monitoring, vadose, boring, CPT, geoprobe, production, irrigation well, etc.
15. Diameter: Specify the cased diameter of the well in inches.
16. Depth: Specify the depth to which the well is to be drilled or the depth of the well destroyed, in feet.
17. Screen intervals: Specify the range of the proposed screen interval or the existing range of the screened interval for each well in feet.
18. Length of time well to remain in use: Provide an estimate for the length of time the well(s) is to remain in use. For example, six months, one year, two years, five years, etc.
19. Total fee due: The permit fee is $110 per permit plus $80 per well. All permits for borings will be charged only $110 regardless of the number of borings. Enter the total amount of fees due.
20. Authorizing Agent/Date: To be completed by the City.
21. Well Permit No.: Assigned by the City at the time the permit is issued.
Download Well Permit Application (in PDF format)
| 
