Applications are available below or may be downloaded from the Florida Department of Health’s Limited Use Wells webpage.  The Limited Use Wells webpage also contains information and a link to Chapter 64E-8, Florida Administrative Code (F.A.C.).

Note: The fee schedules listed in the below applications only reflect the state fees. There may be additional city and/or county fees. Please contact us at 863-773-4161 for complete details.


DH Form 4092A Application for Limited Use Water System Operation (PDF 34.2 KB, link open in a new window)
DH Form 4092B Water System Construction Permit Application (MSWORD 59 KB, link open in a new window)
DH Form 4094 Water System Variance Application (PDF 30.4 KB, link open in a new window)
DH Form 4095 Limited Use Commercial Water System Registration (PDF 35.8 KB, link open in a new window)

Note: Additional fees may be added if field sampling and/or laboratory services are required.