Do I need a notary for the Closed Loop Well System Permit Application?

No. The form has no notary block; the registered contractor signs and dates the certification.

How do I submit the closed loop well permit application?

Submit it to the local health department where the permit is issued. The form says the department retains one copy and issues one copy to the registered contractor.

What attachments does the application require?

Attach a diagram of the system site showing lot size and specified nearby features. If available, attach the original installation report for a modification or sealing application.

What information does the application ask for?

It requests owner and well-site details, the work type and system information, construction or modification details, the work schedule, and registered contractor information and certification.

Randolph County, IL · Randolph County

No notary required

Closed Loop Well System Permit Application

Property owners and registered contractors use this application to request a permit to construct, modify, or seal a closed loop well system.

At a glance

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

What this form is

This application requests a permit to construct, modify, or seal a closed loop well system. It asks for owner and site details, system and work information, and registered contractor information and certification. Applicants must attach a site diagram; the form also describes when to attach an original installation report or a variance explanation.

Who needs it

Property owners and registered closed loop well contractors use this application when seeking a permit to construct, modify, or seal a closed loop well system.

How to submit it

Submit the application to the local health department where the permit is issued. The form states that one copy is retained by the department and one is issued to the registered contractor.

About notarization

This application is signed without a notary; the registered contractor certifies the information by signing and dating the form.

How to submit this form

1
Download the Application
Download the closed loop well system permit application.
2
Complete the Application
Provide the owner, well-site, system, work schedule, and registered contractor information requested on the form.
3
Gather Attachments
Attach the required system site diagram and any applicable original installation report or variance explanation.
4
Submit to the Local Health Department
Submit the application to the local health department where the permit is issued.

Frequently asked questions

Do I need a notary for the Closed Loop Well System Permit Application?: No. The form has no notary block; the registered contractor signs and dates the certification.
How do I submit the closed loop well permit application?: Submit it to the local health department where the permit is issued. The form says the department retains one copy and issues one copy to the registered contractor.
What attachments does the application require?: Attach a diagram of the system site showing lot size and specified nearby features. If available, attach the original installation report for a modification or sealing application.
What information does the application ask for?: It requests owner and well-site details, the work type and system information, construction or modification details, the work schedule, and registered contractor information and certification.

Need something notarized?

This Closed Loop Well System Permit Application doesn’t need a notary, but Illinois residents can notarize other documents online with a commissioned online notary.