Application for New Well Permit (Previously Permitted)

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 $75.00 for each previously permitted well within seven (7) days to the above address.

General:
Well No.
Well Owner:
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.:
Health Dept. I.D.:
(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 Twelve Months:  Million Gal   Amount of Surface Water purchased in the previous twelve months:  Million Gal     Use of Water produced:     Public Supply (Cities and Counties) Domestic/Commercial Industrial Agricultural irrigation Other   No. of acres:      Type of crop: (Pond, golf courses, landscaping, livestock, etc....)   If Other then explain:
Status of this well as of given date:     Operating (Give year drilled) Completed but not being operated (Give year drilled) Being Drilled Awaiting permit to begin drilling
Aggregation:  If this well is to be placed in aggregate with other permitted wells, give lead well number of aggregation:

Applicant/Agent Name:  

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