Pecan Valley
Groundwater Conservation District
New Water Well Registration
Application
Date: Registration
# Driller:
Registration Fee: $3O.OO
(Cash /Check)
Please Print AND Complete all
questions below
Landowner Information:
Name
Mailing Address City Zip
Phone # Cell
#
Lessee (if
applicable):
Name
Mailing Address City Zip
Phone # Cell
#
Mining Company Information (Oil/Gas/Uranium)(if applicable)
Company Name
Mailing Address City Zip
Phone #
Contact Person Phone
#
Well Site Information:
Physical Address of Well Location:
Directions to Well Location:
Number of contiguous acres owned by landowner/water right
holder upon which the well is located
List other known wells located on such property, and
distance from this proposed well location.
Check One or Multiple Proposed Well Use: Domestic Livestock Public Supply Irrigation ____Industrial Injection ___O/G Supply Other:
AGREEMENT:
I agree that this well will be
drilled within (30) feet of the location specified, and that I will furnish the
PVGCD any mechanical log that might be made within ( 120 ) days of completion
of this well. I agree to abide by the
rules of the Pecan Valley GCD, the District Management Plan, and the orders of
the Board of Directors. Furthermore, I
agree not to produce this well without a valid permit, and not to exceed the
production allowance of the Production Limit.
All the information provided in and with this application is true and
correct to the best of my knowledge.
Signature of Landowner or Water Right Holder Date
OFFICE
USE ONLY
Landowner:
Driller:
Well
Coordinates [To be completed by PVGCD Field Agent]
Latitude N Longitude W Elevation ___ ______
Well is located feet
from the property line, and feet from road number
TWDB
Grid Number and Pump Information [To be completed by driller]
TWDB Grid #
Type of Pump HP GPM