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

Application for Groundwater Credit Rebate
Instructions:
Submit one application form and fee within seven (7) days to the above address for each aggregate well system. The application fee is $25.00 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 certificates will be rebated as a percentage of the total amount of water used.

Items marked with an * are required.

*Well No:
 
*Well Owner:
   
*Owner Email:
 
*Mailing Address:
   
*City:
 
*State:
    *Zip:    
*Name of Representative:
   
*Phone Number:
 (###-###-####)       Ext.:  
Permit Term
Current Term - Begin:
 (mm/dd/yyyy)
End:
 (mm/dd/yyyy)
*Previous Allocation:
 (MG), as shown on permit(s).  
*Actual Withdrawal:
 (MG), during the permit term, not calendar year.   
Unused Allocation:**
0.000 (MG)
  **(Previous Allocation - Actual Withdraw)
*Actual Alternative Water Use:
 
 (MG), during the permit term, not calendar year.  
*Staff may request additional supporting documentation or details.
I request that a rebate of that portion of the Groundwater CreditRebate, represented by the unused allocation, 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:
 
*Email Address:
 
*Confirm Email Address:
 
 
1660 W. Bay Area Boulevard  •  Friendswood, TX 77546-2640
Phone: (281) 486-1105  •  Fax: (281) 218-3700
www.subsidence.org