Application for an exemption to the Wellfield Protected Area Designation Order

Form to request permission for activities or land uses that may not comply with the Wellfield Protected Area regulations. 

Please note that an application must be filled out for each property that an exemption is being applied for.

Applicant information

Telephone Number:

Property Owner (if different from applicant)

Telephone Number:

Property information

Wellfield maps may be viewed using the Protected Wellfields Viewer  and the Property Identification Number (PID) provided on the property tax form.

PID number(s):

Zone (A, B, or C):
Zone (A, B, or C):
Zone (A, B, or C):


Your Property Identification Number (PID) can be found on your property tax bill or by contacting Service New Brunswick (1-888-762-8600).

Land use and chemical storage

Type of land use (check one):

Description of land use:

Description of chemical use/storage:

Exemption history

Have you previously requested an exemption from the Minister?

Certification

I hereby certify that the above information is correct to the best of my knowledge.