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

Previously Permitted Well Permit Application
Instructions:
Submit this form for each aggregate well system. Send an application fee of $85.00 for each previously permitted well within seven (7) days to the above address.

Items marked with an * are required.

General
*Well No.
 
*Well Owner:
   
*Owner Email:
 
Correspondent:
 
 
(Fill in the above box only if you wish someone other than the well owner to receive all correspondence.)
*Mailing Address:
   
*City:
 
*State:
    *Zip:    
Attention:
 
(If correspondence is being sent to a large organization, insert the specific person's name to whom you wish it directed.)
*Phone Number:
 (###-###-####)        Ext.:  
(if applicable)
Well Data
Physical Location of Well:
Latitude:
Degrees:
  
  Minutes:
  
  Seconds:
  
Longitude:
Degrees:
  
  Minutes:
  
  Seconds:
  
*Total Depth:
 ft.  
*Depth to First Screen:
 ft.  
*Inside Diameter of Casing:
 in.  
Expected Production During the Next 12 Months:
 
 (MG)  
*Amount of Alternate Water purchased in the previous 12 Months:
 
 (MG)  
 
This only applies to those with meters, or are buying water from another source, or both.
  *Use of Water produced:
 








*Provide detailed description of intended use. If commercial or industrial, describe type of business, number of employees, type of product produced or sold, etc. If for new house or development, include construction start date. If agricultural, include crop type and acreage:
*If Other then explain:
No. of acres:
Type of Crop:
  (Pond, golf courses, landscaping, livestock, etc....)
*Status of this well as of given date:  

Date Drilled 




Operating Date:  (mm/dd/yyyy)
Completed Date:  (mm/dd/yyyy)
If this well is to be placed in aggregate with other permitted wells, give lead well number of aggregation.
Aggregation:
 
 
*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