This form is only used for wells intended to produce greater than 17.36 gallons per minute. In accordance with the Texas Water Code, Chapter 36.113 and District Rules, a non-exempt well requires an operating permit issued by the District.

EXEMPT OR NON-EXEMPT: Our District will determine if your registered well is exempt or not exempt from requiring a well operating permit.  If your well is determined by our District to be “non-exempt”, a well operating permit is required. Download and study this operating permit application form. This form is complex and many applicants need assistance in completing it. We encourage you to visit our office to obtain and complete this form. Bring all your relevant well information and we will help you complete this form while you are in our office.

Payment of the well operating permit fee is required to be included with this Form.

Instructions: This form is used for well operating permit applications only and shall be filled out as completely as possible. In accordance with the Texas Water Code, Chapter 36.113 and District Rules, a non-exempt well requires an operating permit issued by the District.

Well Inspection: District staff shall inspect each well permitted by the District. Property access for inspections is authorized by Texas Water Code, Chapter 36.123 and shall be scheduled with the well owner and conducted in accordance with District Rules. Inspections may include confirming well location, measuring water level, confirming pumping capability, water sampling, geophysical well logging, or any other well-related inspection activity deemed necessary by the District.

Check One (required)

This is a well drilled before February 11, 2002 and equipped with a pump capable of producing more than 25,000 gallons per day (17.36 gallons per minute). This application does not require payment of an application fee.

This is a well drilled after February 11, 2002 and equipped with a pump capable of producing more than 25,000 gallons per day (17.36 gallons per minute). This application requires payment of a $1000 application fee.

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Well Owner

Well Owner Name (required)

Mailing Address (Street/P.O., City, Zip) (required)

Daytime Phone (required)

Alternate Phone

Contact Person (if other than owner)

Contact Phone

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Permit Information for Existing or Proposed Wells

District Well Registration #

State or Temporary Well #

Lot or Tract Size (acres)

Well Used For (required)

Domestic (indicate # of households below)

Public Water Supply

Irrigation

Testing

Monitor

Industrial

Livestock

Pond

Other (specify below)

If domestic, indicate number of households served by well (required)

If other, specify

Single Non-Exempt Well: Requested Annual Production: Gal. per Year

Multi-Well Systems: Requested Annual Aggregate Production: Gal. per Year

If tract of land has more than one well, or if applicant is applying for a multi-well system, provide the State Well Number or District Well Registration Number for other wells:

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Required Attachments

Copy of District Well Registration Form (required)

Well Location Map or Property Plat. Must be drawn to a scale that adequately details the well site, well site access route, property lines, location of other existing or proposed wells on the tract, existing wells on adjoining tracts which may lie within the spacing required for the proposed well, location of surface storage, location of existing water uses if any, location of existing or proposed on-site wastewater systems, and the location of any other potential source of pollution. (required)

Documents Required by District Rules 3.4.A and 3.4.B. (required)

Annual Groundwater Production Calculations. Annual groundwater production requests shall be based, if possible, on historical records, current metered usage, or other accurate measurement methods. If such documentation is not available, the applicant shall provide production calculations based on type of use, pumping capabilities, pumping times, pumping frequency, and other pertinent data to substantiate approximate groundwater production. (required)

Owner’s or Applicant’s Sworn Statement (required)

By signing this application, applicant agrees to avoid waste of groundwater, use reasonable diligence to protect groundwater quality, employ appropriate water conservation practices, and to follow District Rules if and when the well may need to be plugged or abandoned.

I hereby swear and affirm that the information given herein is true and accurate to the best of my knowledge and belief.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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