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

Application For Permit Fee Rebate
Instructions:

PLEASE READ THE FOLLOWING INSTRUCTIONS BEFORE COMPLETING AND RETURNING THIS APPLICATION

  • Submit one application form and fee within seven (7) days to the address below 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.
  • The District will not consider rebates of less than $100.00
  • A water meter must be installed and operating for the entire withdrawal period in accordance with Section 8 of the Rules of the District if a rebate is requested.
  • If the well(s) is for public supply, the ratio of water sold or otherwise accounted for to the total water produced, must be at least 85% during the permit term.


Items marked with an * are required.

*Well No:
   
*Well Owner:
   
*Mailing Address:
   
*City:
 
*State:
    *Zip:    
*Name of Representative:
   
*Phone Number:
 (###-###-####)       Ext.:  
Current (unexpired) Permit
Current Term - Begin:
 (mm/dd/yyyy)
End:
 (mm/dd/yyyy)
*Current Allocation:
 (MG)   
Previous Permit
*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)
*Alternate Water Metered:
 (MG) during the permit term, not calendar year   
*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