Application for Groundwater Credit Rebate

Harris-Galveston Subsidence District
1660 W. Bay Area Boulevard
Friendswood, TX 77546-2640
Phone: (281) 486-1105 Fax: (281) 218-3700

Submit one application form and fee within seven (7) days to the above address for each aggregate well system. The application fee is $75.00 for each well. The form and fee must also be received within ninety (90) days after the termination date of the permit(s) to be considered for a rebate.

Groundwater Certificate will be rebated as a percentage of the total amount of water used.

Well No:  
Name of Well Owner:  
Name of Representative:  
Phone Number:       Ext.:     
Mailing Address:  
City:    State:    Zip:     
Permit Term: Current Term Begins:   Ends:  
Maximum Authorized Withdrawal (MG) as shown on permit(s):     
Actual Withdrawal (MG) during the permit term, not calendar year:     
    

I request on behalf of , that a rebate of that portion of the Groundwater Credit Rebate,  represented by the unused allocation of  (MG), be granted pursuant to Rule 5.6 of the Rules of the Harris-Galveston Subsidence District.

Was a water meter installed and operating for the full permit term.(Explain)  

Applicant/Agent Name:   

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