Fort Bend Subsidence District
Serving the Gulf Coast Community Since 1975

Application for Emergency Permit
Instructions:
Submit this form for each well system.
Send an application fee of $500.00 for each well to be permitted to the address at the bottom of this form within seven (7) days.

Items marked with an * are required.

General Information: 
*Well No:
   
*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:
*Phone Number:
 (###-###-####)       Ext.:
Well Data:
*Physical Location of Well:
   
*Status of this well as of given date:   

Year:  
Year:  

*State the reasons why you cannot wait approximately 75 days for your Permit to be processed. Your statement should include:
1 The reason the application was not submitted in time to allow standard processing (approximately 75 days) and
2. The reason the requestor or owner cannot now follow the normal process.
This portion must include detailed financial losses, health hazards, and/or safety factors that the applicant or owner faces if the standard process is followed.
   
*Applicant/Agent Name:
 
*Submitter's Email:
 
*Confirm Email:
 
 
 
 
 
Richmond, TX 77469-0427  •  P.O. Box 427
Phone: (281) 342-3273  •  Fax: (281) 232-3355
www.fbsubsidence.org