Permit to Construct, Modify or Seal a Closed Loop Well System (Geothermal) Application

To apply for permit to construct, modify, or seal a closed loop system (geothermal) please complete the following form in FULL, print, and mail to the LCHD with corresponding fee. 

Application for Permit to Construct, Modify or Seal a Closed Loop Well System (Geothermal)

Steps

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    1. 310 E. Torrance Avenue, Pontiac, Illinois 61764
      Livingston County Health Department
    2. Application for Permit to Construct, Modify or Seal a Closed Loop Well System

      To apply for construction, modification, or seal a  closed loop system  please complete the following form in FULL, print, and mail to the LCHD with corresponding fee. 

    3. Permit Fee: $100.00
    4. WELL SITE
    5. SYSTEM INFORMATION
    6. Permit
    7. Bore Type
    8. Coolant
    9. CONSTRUCTION INFORMATION
    10. Boreholes:
    11. SYSTEM LOCATION
    12. MODIFICATION INFORMATION
    13. New Boreholes:
    14. Tracing wire locators?
    15. (If the original installation report is available, attach a copy of the report to this form.)
    16. Sealing Information
    17. FOR OFFICIAL USE ONLY
    1. Environmental Health


      Mailing Address
      310 E Torrance Avenue
      Pontiac, IL 61764

      Phone: 815-842-5916
      Fax: 815-842-4070