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Groundwater and surface water collection work

Groundwater and surface water collection work

IMPORTANT : To obtain a permit you must submit all the documents listed below and have completed this form with as much information as possible and in accordance with our municipal bylaws. The inspector assigned to your application reserves the right to require any additional documents or information that may give him a better understanding of your project. Please note that incomplete or missing documents may delay the issuance of the certificate and that misleading information may cancel your application or make your certificate non-valid. This application does not constitute at any time a complete application or an authorization.

1. Identification du propriétaire

2. Identification du requérant (si différente du propriétaire-fournir une procuration )

3. Description des travaux :

4. Use of the building :

Règlement Q-2, r.35.2 sur le prélèvement des eaux et leur protection-MDDELCC
Veuillez cocher la case correspondante :

5. Distance between the well and the purification system

IMPORTANT¯ Provincial Bylaw Q-2, r.22 requires a minimum distance of :
- 15 meters between a well and a sealed water treatment system
- 30 meters between a well and a non-sealed purification system

6. . Identification of the worker

Additional documents or information may be required when analyzing the file

8. . Statement of Applicant

The undersigned declares that the foregoing information is accurate and complete; he undertakes to file all the required documents at the request of the departments concerned. The undersigned also declares that he is aware of the procedure and the applicable municipal Bylaw in force. Finally, the undersigned understands that this form does not constitute a permit granted.