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

Application for Disincentive Fee Rebate
Instructions:
PLEASE READ THE FOLLOWING INSTRUCTIONS BEFORE COMPLETING AND RETURNING THIS APPLICATION:
  • Submit one application form and fee within seven (7) days to the above address for each aggregate well system. The application fee is $75.00for each well. The form and fee must be received within ninety (90) calendar days after the termination date of the permit(s) to be considered for a rebate.
  • A water meter must be installed and operating for the entire withdrawal period in accordance with Section 8 of the Rules of the District if a rebate is requested.



Items marked with an * are required.

*Well Owner:
 
*Owner Email:
 
*Representative:
 
*Mailing Address:
 
*City:
 
*State:
    *Zip:    
 
1. *Well No.:
 
2. Permit Term:
  to  (mm/dd/yyyy)
3. *Permit Allocation:
 (MG)  
4. *Actual Withdrawal:
 (MG) during the permit term, not calendar year.  
5. *Alternate Water Used:
 (MG) during the permit term, not calendar year.  
 
 
*Applicant/Agent:
 
*Phone:
 (###-###-####)      Ext:  
*Submitter's Email:
 
*Confirm Email:
 
 
 
 
 

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