Monroe County, MI · Monroe County
Application to Install Water Supply Facility
A homeowner or applicant completes this application to request a permit to install a water supply facility for a single- or two-family dwelling.
At a glance
- Issued by
- City of Monroe County · Monroe County, Monroe County, Michigan
- Notarization
- Not required: file this form without a notary.
- Official source
- co.monroe.mi.us
- 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 to install a water supply facility for a single- or two-family dwelling. It asks for applicant and owner contact details, the property location and characteristics, well and fee information, and a signature. The form also states that the permit is not transferable and expires one year from issuance.
Who needs it
Homeowners or other applicants seeking a water supply facility permit for a single- or two-family dwelling complete this application.
How to submit it
Submit the application to the Monroe County Health Department, Environmental Health Division, at 2353 S. Custer Road, Monroe, MI 48161-5047. The form lists telephone (734) 240-7900 and fax (734) 240-7948.
About notarization
This application is signed and dated without a notary; it identifies no notarized or sworn attachment, so the applicant just signs and dates it.
How to submit this form
- 1
Download the Application
Download the Water Supply Facility Application.
- 2
Complete the Form
Print or type the applicant, owner, property, and well information requested on the application.
- 3
Sign and Date
Sign and date the application and complete the fee section.
- 4
Submit to the County
Submit it to the Monroe County Health Department, Environmental Health Division, at the address shown on the form.
Frequently asked questions
- Do I need a notary for the Water Supply Facility Application?
- No. The application has a signature and date line but no notary block or sworn attachment; the applicant just signs and dates it.
- How do I submit the Water Supply Facility Application?
- The form names the Monroe County Health Department, Environmental Health Division, at 2353 S. Custer Road, Monroe, MI 48161-5047. It also lists a fax number.
- Who can use this application?
- The application is for a water supply facility serving a single- or two-family dwelling. It asks for applicant, owner, property, well, and fee information.
- What happens after a new well is drilled?
- The form instructs the owner or permit holder to contact the Environmental Health Division to schedule an inspection and water sample collection.