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

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    2. 310 E. Torrance Avenue, Pontiac, Illinois 61764
      Livingston County Health Department
    4. 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. 

    6. Permit Fee: $100.00
    16. WELL SITE
    40. SYSTEM INFORMATION
    42. Permit
    43. Bore Type
    44. Coolant
    49. CONSTRUCTION INFORMATION
    51. Boreholes:
    52. SYSTEM LOCATION
    59. MODIFICATION INFORMATION
    61. New Boreholes:
    64. Tracing wire locators?
    66. (If the original installation report is available, attach a copy of the report to this form.)
    68. Sealing Information
    74. FOR OFFICIAL USE ONLY