Berrien County, MI · Berrien County
Private/Type III Water Supply Permit Application
Berrien County property owners use this application to request a private or Type III water supply permit for a well.
At a glance
- Issued by
- City of Berrien County · Berrien County, Berrien County, Michigan
- Notarization
- Not required: file this form without a notary.
- Official source
- berriencounty.org
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this application to request a permit for a private or Type III water supply, including a new or replacement well, or to indicate well abandonment. It asks for property, owner, and registered well driller information, plus a drawing showing the well’s location in relation to contamination sources. The construction permit does not authorize use of the well before final approval.
Who needs it
Property owners applying for a private or Type III water supply permit should complete the application and provide the requested well and property details.
How to submit it
Submit by email to [email protected], or use one of the listed addresses in Benton Harbor or Niles. The form lists a $280 fee and says payment does not guarantee permit issuance.
About notarization
No notary is required; the applicant signs and dates the form. A well and pump record, final inspection, and safe water sample results are required for final approval.
How to submit this form
- 1
Download the Application
Download the Private/Type III Water Supply Permit Application.
- 2
Complete the Application
Fill in the application type, property and parcel details, owner and driller information, and sign and date the form.
- 3
Add the Well Location Drawing
Draw the well location and dimensions, showing nearby potential contamination sources and indicating north.
- 4
Submit to the County
Email the application to [email protected] or use a listed office address. The form lists a $280 fee.
Frequently asked questions
- Do I need a notary for the Private/Type III Water Supply Permit Application?
- No. The applicant signs and dates the application without a notary. A well and pump record, final inspection, and safe water sample results are required for final approval.
- How do I submit the Private/Type III Water Supply Permit Application?
- Email the application to [email protected] or use one of the Benton Harbor or Niles addresses printed on the form.
- What information does the application request?
- It asks for the property address and parcel details, owner and driller contact information, application type, and a drawing showing the well’s location in relation to possible contamination sources.
- What is needed for final approval?
- After well construction, the form says a water well and pump record must be submitted and approved, BCHD must be notified for a final inspection, and safe water sample results must be received.