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

Application for Renewal of Water Well Permit
Instructions:
Submit this form and fee within seven (7) days to the above address for each well. The application fee is $50.00 ($200.00 for wells that have not been drilled).

Items marked with an * are required.

*Well No:  
*Well Owner:    
*Attention:  
C/O:
*Address:    
*City:      *State:       *Zip:  

*Phone Number:   (###-###-####)       Ext.:  

Latitude:     Degrees:     Minutes:   Seconds:  
Longitude:   Degrees:   Minutes:   Seconds:  
Current Term:Begin:  End:  (mm/dd/yyyy)
*Current Authorized Withdrawal: (MG)  
*Total Pumpage Previous 12 Months: (MG)    

In aggregate with:

*Groundwater withdrawn (prev. 12 months): (MG)  
Alternate water withdrawn (prev. 12 months): (MG)
This only applies to those with meters, or are buying water from another source, or both.
*I request   MG withdrawal for the 12 mon. permit term beginning.
I expect to use   MG of surface water for the same permit term. 
*Use of Water produced:  



No. of acres:   
Type of crop: 
(Pond, golf courses, landscaping, livestock, etc....) courses, landscaping, livestock, etc....)

Comments:  

Please complete the following questionnaire if you are a;  MUD, WCID, FWSD, UD, ID, City, MHPS, SFC, Utility Company, or Apartment (where well is not used for irrigation),ere well is not used for irrigation),

1) Total number of units being served:

Twelve Months Ago

Present

A. Single family residence
B Multi-family units
C Commercial
D **Other
Total Units Served

2) Are all uses metered (This water used for irrigation, city services, etc.)? If not list number and type.

No.     Type:

3) Previous 12 months operation:

A. Total gallons of well water pumped for internal distribution. MG
B. Total gallons of water obtained from outside source for internal distribution MG
Total A+B MG

4) Total gallons of water accounted for by meter readings for last 12 months. MG

5) Interconnects: (Identify entities involved and quantity received or supplied in previous 12 months, if unmeterd indicate it and give an estimate.)n estimate.)

The Above Well Owner (Select One)

Through An Interconnect With

Gallons

 
 

6) Planned growth through next permit term: term:

7) Fax or E-Mail current water rates.

*A unit is a separate user of water whether or not on an individual meter. Example: A duplex is 2 units; a quadruplex is 4 units; etc. Include apartment, condominium, and townhome units.

** List type and number of connectionsof all substantial water consuming facilities not listed in one of the catagories above such as a school, golf course, hotel/motel, etc.

*Applicant/Agent Name:   Applicant/Agent Phone:  (###-###-####) Ext.:

*Please enter your e-mail address:   
*Please re-enter your e-mail address:  

 

1660 W. Bay Area Boulevard  •  Friendswood, TX 77546-2640
Phone: (281) 486-1105  •  Fax: (281) 218-3700
www.subsidence.org