GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES
Groundwater Appropriation Permit Application GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION 45 MARS HILL FREDERIKSTED, ST. CROIX, VI 00840 PHONE: (340) 773-1082, FAX: (340) 773-9310 APPLICATION FOR GROUNDWATER APPROPRIATION New______ Renewal_____ In compliance with Title 12, Chapter 5, Virgin Islands Code, the undersigned ______________________________________________________________________________ Name of Property Owner ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Mailing Address ______________________________________________________________________________ Telephone Number Hereby applies for a permit to appropriate groundwater. …
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Groundwater Appropriation Permit Application GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION 45 MARS HILL FREDERIKSTED, ST. CROIX, VI 00840 PHONE: (340) 773-1082, FAX: (340) 773-9310 APPLICATION FOR GROUNDWATER APPROPRIATION New______ Renewal_____ In compliance with Title 12, Chapter 5, Virgin Islands Code, the undersigned ______________________________________________________________________________ Name of Property Owner ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Mailing Address ______________________________________________________________________________ Telephone Number Hereby applies for a permit to appropriate groundwater. The well(s) will be located at: ________________________________________________ (Estate, Lot Number and Island) _______________________ (Property Tax Number) __________________________ (Well Drilling Permit Number; if applicable) Proposed use of well(s): (Check ONE use only): 1. Domestic______ Number of apartment’s: ______________________ Number of people to be served: ________________ 2. Farm Operation_______ Groundwater Appropriation Permit Application Land acreage reserved for crops: _________________________________ Type and number of livestock: ___________________________________ 3. Commercial (water sales)______ Estimated water production: ______________gal/day Proposed cost of water at site: _____________per 1,000 gal. 4. Municipal ___________ Area to be served: _______________ Estimated population to be served: ___________________ 5. Other (laundry, etc.) __________ Details: _________________________________________ Planning for Development (explain the use of the water): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Estimated quantity of water proposed to be extracted daily: ____________ gal/day Name of proposed Driller & License Number (if applicable): __________________________ Fee of $10.00 is attached. (If check, please make payable to the Government of the Virgin Islands). _____________________________ ________________ Signature of Property Owner Date FOR DEPARTMENT USE ONLY: DATE: __________________ APPROVED: ________ DISAPPROVED: _________ REMARKS and/or SPECIAL CONDITIONS: ______________________________________________________________________________ ____________________________________________________________ SIGNATURE OF WELL INSPECOR: ___________________________________ GROUNDWATER APPROPRIATION PERMIT NUMBER (if approved): ______________