Fort Bend Subsidence District
Serving the Gulf Coast Community Since 1975

Original Application for Existing Well
Instructions:
Submit this form for each aggregate well system. Send an application fee of $200.00 for each well within seven (7) days to the address below.

Items marked with an * are required.

General
*Well Owner:
 
*Email Address:
 
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.:  
Site No.:
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 12 Months:
 
 (MG)
  Intended Use:
 








*Provide detailed description of intended use. If commercial or industrial, describe type of business, number of employees, type of product produced or sold, etc. If for new house or development, include construction start date. If agricultural, include crop type and acreage:
*If Other then explain:
No. of acres:
Type of Crop:
  (Pond, golf courses, landscaping, livestock, etc....)
  Status of this well as of given date:
 
-- Year Drilled:
 
-- Year Drilled:  
 
If this well is to be placed in aggregate with other permitted wells, give lead well number of aggregation.
Aggregation:
 
*Applicant/Agent Name:
 
*Email Address:
 
*Confirm Email Address:
 
 
 

Richmond, TX 77469-0427  •  P.O. Box 427
Phone: (281) 342-3273  •  Fax: (281) 232-3355
www.fbsubsidence.org