The Well Driller's Authorization Letter is a form of the County of Sacramento Environmental Management Department (EMD) that designates an authorized representative to procure permits for wells and soil borings. It is not a business license: it records the well driller, the site, the C-57 license and the entity or entities acting on the signer's behalf. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the form is published by EMD, which lists it among its Water Program and Well Forms.
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What is Well Driller's Authorization Letter – Sacramento County, CA?
The Well Driller's Authorization Letter is a one-page letter, issued on County of Sacramento Environmental Management Department (EMD) letterhead, in which the signer designates one or more entities to act as an authorized representative for the sole purpose of procuring well and soil boring permits at a stated site.
The letter covers permits for the construction, modification, repair or destruction of wells or soil borings, and for the installation, repair or replacement of well pumps at the site named at the top. It identifies the well driller by name, address, phone number, C-57 license number and license expiration date, then lists the designated entity by name, company, address, city, state and ZIP code.
By signing, the applicant acknowledges two things printed on the form: as the applicant for permits for activities regulated under Chapter 6.28 of the Sacramento County Code, the signer remains responsible for compliance with all provisions of that chapter, and the authorization can be rescinded by written notification to EMD.
The form is listed on the EMD page Water Program and Well Forms, under Wells, with a last-updated date of 06/18/2025. The same list includes a separate Property Owner's Authorization Letter, which is a different document. The letter is not a business license and does not authorize work by itself; it only names who may obtain the permits.
Who needs to file Well Driller's Authorization Letter – Sacramento County, CA?
The letter is used by the person or company that signs as applicant for well or soil boring permits regulated under Chapter 6.28 of the Sacramento County Code and wants another entity to procure those permits as its authorized representative. The form asks for the well driller's details, including a C-57 license number and its expiration date, and for the signer's title: RMO, RME or Officer.
It applies only to the activities the form lists: construction, modification, repair or destruction of wells or soil borings, and installation, repair or replacement of well pumps at the site address entered on the form.
The letter does not release the signer from responsibility. The form states that the applicant remains responsible for compliance with all provisions of Chapter 6.28, even when a designated entity procures the permits.
If you need an authorization from a property owner instead, EMD lists a separate Property Owner's Authorization Letter on its Water Program and Well Forms page; this form does not replace it.
When to file Well Driller's Authorization Letter – Sacramento County, CA
Complete the letter when you want an entity to procure well or soil boring permits on your behalf for a specific site; the form sets no separate due date. It is tied to the permit work it names, so have it ready when the permit is requested from EMD.
The authorization is not fixed in time. The form says you may rescind it upon written notification to EMD, so if the designated entity should no longer act for you, notify EMD in writing. The C-57 license expiration date entered at the top should be current when you sign. The printed revision date is 6/18/25.
How to fill out Well Driller's Authorization Letter – Sacramento County, CA
Enter the site address
Under the heading, write the Site Address where the well, soil boring or pump work will take place. The authorization applies to that site.
Enter the well driller details
Fill in Well Driller, Driller's Address and Driller's Phone No. exactly as they should appear for the permit.
Add the C-57 license information
Enter the C-57 License No. and its Exp. Date.
Name the authorized representative
Under the designation statement, write the Name(s) and Company of each entity you authorize to procure the permits.
Enter the representative's address
Complete Address and City, State, Zip for the designated entity.
Read the acknowledgments
Confirm you understand that, as applicant under Chapter 6.28 of the Sacramento County Code, you remain responsible for compliance, and that you can rescind the authorization by written notice to EMD.
Sign and print your name
Sign on the Signature line and enter your name on the Printed line.
Enter your title and the date
Write your title (RMO, RME or Officer) and the Date.
Review and download the completed PDF
Check the site address, license number and expiration date, then download or print the completed PDF from FillingPDF and send it to EMD as described under How to submit.
How to submit Well Driller's Authorization Letter – Sacramento County, CA
The form prints no submission channel of its own; it supports permit applications handled by the Sacramento County Environmental Management Department (EMD), so confirm with EMD how it should accompany the permit request.
- Mail or in person: EMD's address on the form is 11080 White Rock Rd, Suite 200, Rancho Cordova, California 95670.
- Phone: General (916) 875-8581; Environmental Health (916) 875-8440; Environmental Compliance (916) 875-8550.
- Website: emd.saccounty.gov, where the form is listed under Water Program and Well Forms.
To rescind the authorization later, send written notification to EMD, as the form states. FillingPDF lets you fill out and download the PDF; submission follows the channels EMD provides.
Common mistakes to avoid
- Treating the letter as a Sacramento County business license; it only designates a representative to procure well and soil boring permits.
- Leaving out the C-57 License No. or its Exp. Date in the well driller block.
- Using the letter for anything beyond permits for wells, soil borings or well pumps; the form says the authorization is for that sole purpose.
- Signing without the printed name and without a title of RMO, RME or Officer.
- Assuming the designated entity takes over your responsibility; the form states the applicant stays responsible for compliance with Chapter 6.28.
- Trying to cancel the authorization without written notification to EMD, which is how the form says it is rescinded.
- Confusing this letter with the Property Owner's Authorization Letter, a separate EMD form.
Frequently asked questions
What is the Well Driller's Authorization Letter?
It is a Sacramento County Environmental Management Department (EMD) form in which the signer designates an authorized representative to procure permits for wells, soil borings and well pump work at a named site. It is used only for that purpose.
Is this a Sacramento County business license?
No. The letter does not license a business. It names the well driller, the site and the entity authorized to procure well and soil boring permits, and the signer remains responsible under Chapter 6.28 of the Sacramento County Code.
Can I fill out the Well Driller's Authorization Letter online?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not send the letter to EMD; you provide it through the channels EMD uses.
How do I cancel a well driller authorization?
The form says you may rescind the authorization upon written notification to EMD. Send the written notice to the Environmental Management Department; the form prints its address at 11080 White Rock Rd, Suite 200, Rancho Cordova, California 95670.
Who signs the letter and what title is entered?
The signer signs, prints their name and enters a title, which the form lists as RMO, RME or Officer, along with the date. The signer is the applicant who accepts responsibility for compliance with Chapter 6.28.
What is the difference between this letter and the Property Owner's Authorization Letter?
They are separate EMD forms. EMD lists the Property Owner's Authorization Letter next to the Well Driller's Authorization Letter under Wells, both updated 06/18/2025. This page covers only the well driller's letter.
Where do I get help with this form?
Call EMD: General (916) 875-8581, Environmental Health (916) 875-8440 or Environmental Compliance (916) 875-8550. The office is at 11080 White Rock Rd, Suite 200, Rancho Cordova, California 95670, and the website is emd.saccounty.gov.
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