Government of Newfoundland and Labrador
Department of Municipal Affairs and Environment
Water Resources Management Division
Application for Water Well Drilling Licence
Subject to Section 56 of the Water Resources Act SNL 2002 cW-4.01, the undersigned applies for a licence to carry on the business of water well drilling in the Province of Newfoundland and Labrador for the year , and in support thereof makes the following statements of fact:
Name of person (Applicant) / Affiliated CompanyStreet Number/PO Box / Street Name
Community / Province / Postal Code
Phone Number
() / Fax Number
() / Email Address
Alternate Address (if different from above)
Street Number/PO Box / Street Name
Community / Province / Postal Code
Phone Number
() / Fax Number
() / Email Address
Name / Position / YearsofExperience / Relevant Courses Completed**
*Please provide additional names and information on a separate sheet
**Please provide proof of courses for all names listed above
Please list all water well drilling machines owned and operated by applicant
Water Well Drilling Machine / Plate NumberSize of holes applicant is equipped to drill
Applicant will be drilling:
Full TimePart Time
Area(s) of the province in which applicant will be operating:
I certify that the information in this application is true, complete and accurate. This is a legal document and it is an offence to make a false statement or to falsify any information.
A cheque for$400+ HST, made payable to the Newfoundland Exchequer Account, is attached. Account# 1761-500-57M0-2764 - HST MPA-Water Rights (H)Registration No: 107442683
Applicant's Name (Please Print)Signature of ApplicantDate
Forward completed application and fee to:
Attention: Dorothea Hanchar
Department of Municipal Affairs and Environment
Water Resources Management Division
PO Box 8700
St. John's, NL, A1B 4J6
If you have any questions or require assistance, please contact please contact the environmental scientist at (709) 729-1671 or email