Application for New Well Permit (Existing Well)

Application for New Well Permit (Existing Well)

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 aggregate well system. Send an application fee of $200.00 for each well within seven (7) days to the above address.

General:
Well Owner:
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.:
Health Dept. I.D.:	Site No.:
(if applicable)

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 Twelve Months: Million Gal

Use of Water produced:

Public Supply (Cities and Counties) Domestic/Commercial Industrial Agricultural irrigation Other
	No. of acres: Type of crop: (Pond, golf courses, landscaping, livestock, etc....)

If Other then explain:

Status of this well as of given date:

Operating (Give year drilled)
Completed but not being operated (Give year drilled)
Being Drilled
Awaiting permit to begin drilling

Aggregation: If this well is to be placed in aggregate with other permitted wells,

give lead well number of aggregation:

Applicant/Agent Name:

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