What work does the Water Well Permit Application cover?

It requests a permit for water well construction, modification, repair, or destruction. The form marks new construction, modification, and repair as requiring a supplemental application.

What attachments does the application require?

Attach a plot plan showing the listed features within 200 feet of the well, including property lines, wastewater systems, water bodies or watercourses, drainage patterns, and other wells.

How do I submit the Water Well Permit Application?

Submit it to the Humboldt County Division of Environmental Health at 100 H Street, Suite 100, Eureka, CA 95501. The form also lists an email address.

Humboldt County, CA · Humboldt County

No notary required

Water Well Permit Application

Property owners and drilling contractors use this application to request a Humboldt County permit to construct, modify, repair, or destroy a water well.

At a glance

Issued by: City of Humboldt County · Humboldt County, Humboldt County, California
Notarization: Not required: file this form without a notary.
Official source: humboldtgov.org
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

Use this application to request a permit from the Humboldt County Division of Environmental Health for water well construction, modification, repair, or destruction. It asks for applicant, owner, parcel, site, intended-use, contractor, and well-design information. A plot plan showing specified features within 200 feet of the well must be attached; new construction, modification, and repair also require a supplemental application.

Who needs it

Property owners and drilling contractors seeking a Humboldt County permit for water well construction, modification, repair, or destruction need this application.

How to submit it

Submit the application to the Humboldt County Division of Environmental Health, 100 H Street, Suite 100, Eureka, CA 95501; the form also lists [email protected].

About notarization

This document is signed and dated without a notary; it requires a plot plan attachment, but does not say that the plot plan or any related step must be notarized or sworn.

How to submit this form

1
Download the Application
Download the Water Well Permit Application PDF.
2
Complete the Application
Fill in the applicant, owner, site, intended-use, contractor, and well-design information.
3
Gather Required Attachments
Attach a plot plan showing the features listed on the form within 200 feet of the well. Include a supplemental application for new construction, modification, or repair.
4
Submit to the County
Submit the application to the Humboldt County Division of Environmental Health at the address listed on the form.

Frequently asked questions

What work does the Water Well Permit Application cover?: It requests a permit for water well construction, modification, repair, or destruction. The form marks new construction, modification, and repair as requiring a supplemental application.
What attachments does the application require?: Attach a plot plan showing the listed features within 200 feet of the well, including property lines, wastewater systems, water bodies or watercourses, drainage patterns, and other wells.
Do I need a notary for the Water Well Permit Application?: No. This application is signed and dated without a notary. It requires a plot plan attachment, but does not say the plan or a related step must be notarized or sworn.
How do I submit the Water Well Permit Application?: Submit it to the Humboldt County Division of Environmental Health at 100 H Street, Suite 100, Eureka, CA 95501. The form also lists an email address.

Need something notarized?

This Water Well Permit Application doesn’t need a notary, but if you have another Humboldt County form that does, a commissioned online notary can help.