Hydrology Applications – Ministry of Natural Resources

Hydrology Checklist Permission to Drill a Well

Hydrology - Well Drilling Operations Consent Form

FORM BZ/WIA/0002 Water Industry Act 2003 CHAPTER 222, Part V, Chapter II PERMIT APPLICATION WELL DRILLING OPERATIONS CONSENT FORM

FORM BZ/WIA/0002

Water Industry Act 2003
CHAPTER 222, Part V, Chapter II
PERMIT APPLICATION
WELL DRILLING OPERATIONS CONSENT FORM
Please read through this form and write clearly in the answer spaces.
1.0 Applicant Name
(a) Applicant Name*
Prefix First Last
(b) Name of Company or organization, (if applicable)
(c) Registration Number, if applicable
(d) Social Security Number:
1.2 Address
Address
Street Address Address Line 2 City District Country
1.3 Contact Numbers, including the area code
Phone
Mobile
Email
Email 2
1.4 What is the nature of your interest in the land where well-drilling is to take place?
What is the nature of your interest in the land where the well-drilling is to take place?
- Owner
- Lessee
- Tenant
- Other
1.4 Other Interest
2.0 Drilling Contractor Details:
2.1 Name of Drilling Contractor*
Prefix First Last
Address of Drilling Contractor
Street Address Address Line 2 City District Country
3.0 Location/Technical Details:
3.1 Location of Proposed /Existing Work:
3.2 Groundwater Province Name:
Well Name:
Well point (Coordinates)
(i) Estimated depth of borehole or well (metres/feet)
(ii) Diameter of borehole or well (centimetres/inches)
(iii) In the case of artesian supplies, the method proposed for controlling the flow from the borehole and for preventing leakage around the borehole lining
(iv) Volume of water required (m^3/day)
3.3 Method of Drilling
3.3 Method of Drilling
Note:
Completed forms must be accompanied by - (where applicable)
1. (1) Two copies of a map on a scale of 1:50,000 showing location of works, well (s);
2. (2) Copy of Well Driller Licence;
3. (3) Such other documents as the NHS may require; and
4. (4) Application fee of BZ$500.00
I hereby apply for a well drilling permit under the Water Industry Act and declare that to the best of my knowledge and belief the particulars set out in this application are true and correct.

Signature of Applicant Date

Hydrology - Well Drilling Operations Consent Form

Please read through this form and write clearly in the answer spaces.

1.0 Applicant Name

1.2 Address

1.3 Contact Numbers, including the area code

1.4 What is the nature of your interest in the land where well-drilling is to take place?

2.0 Drilling Contractor Details:

3.0 Location/Technical Details:

3.3 Method of Drilling