DIVISION OF

ENVIRONMENTAL PROTECTION



PH # (340) 774-3320

FAX # (340) 714-9528



GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS



a an



DEPARTMENT OF PLANNING AND NATURAL RESOURCES



DIVISION OF ENVIRONMENTAL PROTECTION

CYRIL E. KING AIRPORT

TERMINAL BUILDING, SECOND FLOOR

ST. THOMAS, U.S. V.1, 00802



APPLICATION FOR PERMIT TO DRILL WELL



In compliance with Title 12, Chapter 5, Virgin Islands Code, the undersigned



Name of Driller & License Number



Mailing Address



Telephone Number

hereby applies for a permit to:

C] Drill a well



C) Deepen an exiting well

QO Clean and Refurbish an existing well on the property



Name of Property Owner



(Estate, Lot Number and Island)



(Property Tax Number)

The well will be drilled to the approximate depth of Feet and will be Inches

in diameter. It will have Feet of casing, constructed of Material,

Feet of screening of (Description of screen) and will

have (Proposed type of casing seal).



Purpose of Well

Well Drilling Permit Application

Page 2.



The attached sketch (property map from Cadastral Survey) shows location of proposed well relative

to existing buildings or other physical features, the location of existing wells on the property or

nearby adjacent properties, and the location of all known sources of contamination in the vicinity.



Lf pump will be installed by driller, answer the following:



Capacity of Pump Horsepower Size

(GPM) (HP) (Inches)



A log showing the various strata or formations intersected by the well, formation yields and quality,

and casing and screening details will be forwarded to the Division of Environmental Protection within

thirty (30) days after completion of drilling operations.



Fee of $10.00 is attached. (If paying by check, please make payable to the Government of the

Virgin Islands).



Signature of Property Owner Date



Signature of Well Driller Driller’s License Number



FOR DEPARTMENT USE ONLY:



DATE: APPROVED: DISAPPROVED



REMARKS and/or SPECIAL CONDITIONS:



SIGNATURE OF WELL INSPECTOR:



DRILLING PERMIT NUMBER (If approved):

drwlappl/retyped 2/2001