Application for Groundwater Credit Rebate

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

Submit one application form and fee within seven (7) days to the above address for each aggregate well system. The application fee is $25.00 for one (1) well, or if you have more than 1 well, a total of $50.00 is due for the entire aggregate system. 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.

Groundwater Certificate will be rebated as a percentage of the total amount of water used.

Well No:  
Name of Well Owner:  
Name of Representative:  
Phone Number:       Ext.:     
Mailing Address:  
City:    State:    Zip:     
Permit Term: Current Term Begins:   Ends:  
Maximum Authorized Withdrawal (MG) as shown on permit(s):     
Actual Withdrawal (MG) during the permit term, not calendar year:     
Actual alternative water use (MG)* during the permit term, not calendar year:    
*Staff may request additional supporting documentation or details.
    
I request on behalf of , that a rebate of that portion of the Groundwater Credit Rebate,  represented by the unused allocation of  (MG), be granted pursuant to Rule 5.6 of the Rules of the Fort Bend Subsidence District.
Was a water meter installed and operating for the full permit term.(Explain)  

Applicant/Agent Name:   
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