Harris-Galveston Subsidence District
Serving the Gulf Coast Community Since 1975

Annual Report for Water Pumpage
Instructions:
Submit this form for each well covered by a Water Well Permit.  Where wells have been permitted for aggregate withdrawal, only one form per aggregation need be completed.

Items marked with an * are required.

*Pumpage Year:   
*Lead Well No: 
*No. of Wells in aggregate:  

Well No(s) in aggregate: 

 

*Name of Well Owner: 

Groundwater Withdrawal:

(Report the amount of groundwater withdrawn for each month in gallons, not the actual meter readings)
Do not use commas, enter numbers in actual gallons.   

Gallons

Gallons

Jan. Jul.
Feb. Aug.
Mar. Sept.
Apr. Oct.
May Nov.
Jun. Dec.
*Total for year:  (Gal)  
*Water Was Used for: 

Other:
Agricultural Users:  Type of Crop: Number of Acres:  
*How did you measure the water used? 

Other:
*Is surface water or groundwater obtained from any other source?    
If yes, name the source  State the annual amount  (Gal)

*Applicant / Agent Name:   

*Phone Number:   (###-###-####)   Ext.: 
*Please enter your e-mail address:   
*Please re-enter your e-mail address:  

 

1660 W. Bay Area Boulevard  •  Friendswood, TX 77546-2640
Phone: (281) 486-1105  •  Fax: (281) 218-3700
www.subsidence.org