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Dawson County Community Development 25 Justice Way I Dawsonville, Georgia 30534 I706.344.3604 dawsoncountyga.gov NOTICE OF INTENT TO DRILL A WELL In Dawson County, the undersigned intends to drill a well. The well's intended usage is to supply water for the following uses: Single-family dwelling Agriculture; Irrigation Other: Owner’s Name: Owner’s Address: Owners Phone Number: Email: Print Owner’s Name: Owner’s Signature: Date: If a letter from a central water provider is not included with the permit application, this form just verifies that the applicant intended to supply the property via a well; state agencies do not use it. Dawson County Community Development is the only entity permitted to utilize this document. The Georgia Environmental Protection Division's WWSAC NOI is not represented by it.