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Well Upgrading Application Form

Please use this form if you are planning a well upgrade. Use the Well Decommissioning Application form if you are planning to decommission a well.

If you require assistance or an alternate format of this application, please call: 519-364-1255 ext 279.

Applicant Information

Applicant Name:

Date:

Phone Number:

Email Address:

Mailing Address:

City/Town:

Postal Code:

Legal Address of Well (including lot number and concession if known):

Well Municipality/Former Township: