Private Well Initiative - Water Sampling Results Tool Place Holder | Department of Health

Water & Sewer Application Request for Loan Letters

Step 1: Info Form

Step 2: Confirmation

Step 3: Payment

Lending Entity/Banking Institution Information

Louisiana Department of Health will mail the letter directly to the requesting entity. Please provide their information below:

*Denotes a required field.

Entity/Bank Name

*Address

Address 2

*City

*State

*Zip

Well/Property Location

Enter the property owner's information below:

*Denotes a required field.

*Property Owner First Name

*Property Owner Last Name

*Physical Address

Physical Address 2

*City

*State

*Zip

*Parish

*Email

How would you like to receive your testing results?
Email Standard Mail Both