Annual Report for Water Pumpage

Fort Bend Subsidence District
P.O. Box 427
Richmond, TX 77469-0427
Phone: (281) 342-3273 Fax: (281) 232-3355

Instructions:  Submit this form for each well covered by a Water Well Permit.  Where wells have been permitted for aggregate withdrawal, only one form per aggregation need be completed.
Pumpage Year:   
Lead Well No:   
No. of Wells in aggregate:   

Well No(s) in aggregate: 

 
Name of Well Owner: 

Groundwater Withdrawal:
(Report the amount of groundwater withdrawn for each month in gallons, not the actual meter readings)
Do not use commas, enter numbers in actual gallons.   

Gallons

Gallons
Jan.   Jul.  
Feb.   Aug.  
Mar.   Sept.  
Apr.   Oct.  
May   Nov.  
Jun.   Dec.  
Total for year:  (Gal)   
Water Was Used for: 
                                                                                   
(Agricultural Users:  Type of Crop: Number of Acres: )  
How did you measure the water used? 
                                                                                
Is surface water or groundwater obtained from any other source?    
If yes, name the source  State the annual amount  (Gal)  

Applicant / Agent Name: 

  Phone Number:   Ext.:   
         
Please enter your e-mail address:    
Please re-enter your e-mail address: