Application For Permit Fee Rebate

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

PLEASE READ THE FOLLOWING INSTRUCTIONS  BEFORE COMPLETING AND RETURNING THIS APPLICATION: Submit one application form and fee within seven (7) days to the above address 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.

Well No:

Well Owner:

Mailing Address:

City:    State:    Zip:

Name of Representative:

Phone Number:          Ext.:

Current Term:     Begin:   End:

Current Allocation:

Maximum Authorized Withdrawal (MG) as shown on permit(s):

Actual Withdrawal (MG): during the permit term, not calendar year:

Applicant/Agent Name:  

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