Application For Amended Permit  (Transfer of Ownership) 

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

Instructions:  Submit this form for each aggregate well system.  Send an application fee of  $25.00  within seven (7) days for each well to be permited to the above address.

Rule 5.4     Permit Amendments c.  Permit Amendment to Transfer Ownership of the Permit: An application to amend the permit to change the name of the permittee must be made within 90 calendar days of the change in ownership of the permitted well.  The General Manager may grant such an amendment without notice, hearing, or further action by the Board.

Well No:	(Submit one form for each well.)
Current Permittee:
New Owner:
Address:
City:	State:    Zip:
Attn:
Phone Number:	Ext.:
Date of Ownership change:

I CERTIFY THAT THE FOREGOING STATEMENTS ARE TRUE AND CORRECT TO THE BEST OF MY ABILITY.

Applicant/Agent Name:  

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