Tooele Health Department
             
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444
eh@TooeleCo.gov
Application for Well / Spring Water Permit

Please put N/A for any fields that are not applicable
Permit fee must be paid before permit will be issued.
Permit is only valid for 24 months from date of application.
Any changes must be approved in writing by TCHD.
Additional fees may be required for repeat samples, additional sampling parameter, or lab fee increases.
Start Card, proof of water rights from the Division of Water Rights, and 
plat/map indicating location of the well must be submitted with the application
Please email forms to eh@tooeleco.gov
 
Date
Owner Name
Owner Phone Number
Mailing Address
Email Address
Site Address or Legal Description
Parcel Number
Subdivision
Lot Number
Well Driller's Name
Phone Number
Will this be a shared well?
Yes (If on a shared well, please submit a copy of the Shared Well Agreement and specify which lot the well is located on)
No
Individual Well Permit:   $150.00   Item Subtotal:  
$150.00
Chemical Analysis Water Sample Fee:   $350.00   Item Subtotal:  
$350.00
Rush Fee (optional) = Additional Fee of $130:   $130.00   Select:   Item Subtotal:  
$0.00
Total:
$500.00
 

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