Well Mitigation

Property Information
Assessor's Parcel #
Property Address

Street Address

Address Line 2
Owner Information

First

Last
Mailing Address

Street Address

Address Line 2
Phone
Email
Property & Utility Information Questionnaire
1. Does your property current have a domestic well?
2. If yes, has it been deepened or redrilled?
3. When was the work performed?

Month

Day

Year

Please give approximate time frame
4. Were you the owner of the property at the time of the deepening?
5. Do you have records showing the date and cost of the deepening?

Please provide copies of receipts and well drillers report, if available
6. Did your property previously have a domestic well, but is now connected to a municipal water system?

If property is now connects to the water system, answer #7-#9
7. When was your property connected to the municipal water system?

Month

Day

Year

Please give approximate time frame
8. Were you the owner of the property at the time of connection?
9. What connection fees were paid for the water service connection?

Type answer above.
Please select one of the following:
Other

Property Information