Application For Permit Fee Rebate

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

PLEASE READ THE FOLLOWING INSTRUCTIONS  BEFORE COMPLETING AND RETURNING THIS APPLICATION:

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.

The District will not consider rebates of less than $100.00

A water meter must be installed and operating for the entire withdrawal period in accordance with Section 8 of the Rules of the District if a rebate is requested.

If the well(s) is for public supply, the ratio of water sold or otherwise accounted for to the total water produced, must be at least 85% during the permit term.
Well No:   
Well Owner:    
Mailing Address:    
City:    State:    Zip:     
Name of Representative:    
Phone Number:          Ext.:    
Current Term:     Begin:   End:  
Current Allocation:       
Maximum Authorized Withdrawal (MG) as shown on permit(s):   
Actual Withdrawal (MG): during the permit term, not calendar year:       
Surface Water Purchased (MG): during the permit term, not calendar year:       
   

Applicant/Agent Name:  

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