District Use OnlyAmount ReceivedDate Received

WP-61-4311SANTA CLARA VALLEY WATER DISTRICT

Well Permit Fee Calculation Form

Consultant/Driller Company___________________________Contact Name_______________________________Contact Telephone___________________________Address of Permit Activity _________________________________

_________________________________

Check if permit applications were also emailed

Permit Type Number of Permits

Permit Fee Total Fee Per Permit Type(number of permits x fee =)

Well Construction

$500 per well

Well Destruction $410 per wellWell Reconstruction

$230 per well

Geothermal Heat Exchange Well

1 See Below

Exploratory Boring

$375 per site/event

Standby Well Permit

$375 initial$275 extension

TOTAL AMOUNT ENCLOSED

Geothermal Heat Exchange Well Permit Fee ScheduleNumber of Wells in Proposed System Permit Fee1 to 5 $7006 to 10 $93011 to 20 $1,30021 to 50 $2,12551 to 100 $2,800101 to 200 $5,625201 to 300 $8,435More than 300 $11,250

Please mail permit applications, this fee calculation form, and the appropriate permit fee (check or money order) to: Well Permits

Santa Clara Valley Water District5750 Almaden ExpresswaySan Jose, CA 95118-3614

Make checks/money orders payable to: Santa Clara Valley Water District