Monroe County, MI · Monroe County
Request for Deviation Water Well Installation
Property owners use this form to request a deviation for installing a water well at an existing single- or two-family residential 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
This form requests a deviation to install a water well at an existing single- or two-family residential dwelling when an evaluation identifies conditions affecting well installation. It asks for the parcel address, township, property ID, evaluation findings, requested deviation, and owner signatures and dates. The form includes a review section for the request outcome and comments.
Who needs it
Owners of a parcel with an existing single- or two-family residential dwelling may use this form to request a water well installation deviation.
How to submit it
Submit the request to the Monroe County Health Department Environmental Health Division, 2353 South Custer, Monroe, Michigan 48161. The form lists telephone (734) 240-7900.
About notarization
This document is signed and dated by the owner without a notary; it does not identify a notarized or sworn attachment or related step.
How to submit this form
- 1
Download the Form
Download the Request for Deviation Water Well Installation form.
- 2
Complete the Request
Enter the parcel address, township, property ID, evaluation findings, and requested deviation.
- 3
Sign and Date
Have the owner or owners sign and date the request.
- 4
Submit to the County
Submit the form to the Monroe County Health Department Environmental Health Division at the address printed on the form.
Frequently asked questions
- What does the water well deviation request form do?
- It lets owners request a deviation to install a water well at an existing single- or two-family residential dwelling when an evaluation finds conditions affecting installation.
- What information does the form ask for?
- The form asks for the parcel address, township, property ID, evaluation findings, requested deviation, and owner signatures and dates. It also has a section for the review outcome and comments.
- Do I need a notary for the Water Well Installation Deviation Request?
- No. The document has owner signature and date lines but no notary block; the owner signs and dates it.
- How do I submit the Water Well Installation Deviation Request?
- Submit it to the Monroe County Health Department Environmental Health Division at 2353 South Custer, Monroe, Michigan 48161. The form lists telephone (734) 240-7900.