$100 FEE 2026

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  1. Click ‘Get Form’ to open the $100 FEE document in the editor.
  2. Begin by reviewing the instructions carefully. Ensure you are using black or blue ink if filling out manually.
  3. In Section 1, if applicable, obtain approval from your county or local health authority. Check the appropriate box and provide their contact information.
  4. Proceed to Section 2 to fill in registry information. Select the well type and proposed action, then specify the location details including township and range.
  5. Complete Section 3 with owner information. If you are both the landowner and well owner, check the corresponding box.
  6. In Section 4, answer all questions regarding site conditions and existing wells. This is crucial for compliance.
  7. Fill out Sections 5 through 10 as required, ensuring all fields marked in red are completed accurately before submission.

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2023 4.9 Satisfied (34 Votes)
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