Fayette County Groundwater Conservation District

255 Svoboda Lane, Room 115

La Grange, Texas 78945

Phone: 979-968-3135

email: wendi@fayettecountygroundwater.com

WATER USE REPORT

Well Owner Name

Well Owner Email

Permit Number

Year of Production

Please complete listing the amount of water use for each individual type of use. If this well is used in an aggregated system, under "Acres", please list the total amount of acres in the system. PLEASE CONVERT ALL GALLONS INTO THE MEASUREMENT OF ACRE FOOT.

1 acre foot = 325,851 gallons. Please carry out "Amount of Water" to three decimal places.

Please provide Amount of Water Used in Acre Feet below:

January

February

March

April

May

June

July

August

September

October

November

December

Total Annual Volume (acre feet)

If used for irrigation - Please provide number of acres irrigated

Measurement Method

Meter

GPM X Hours Run

Please explain your method of measuring your water usage

Applicant agrees that water produced/withdrawn from the permitted well was put to beneficial use at all times.

I, well owner/well operator, hereby certify that the information given herewith is true and accurate to the best of my knowledge and belief.

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FAYETTE COUNTY GROUNDWATER CONSERVATION DISTRICT

FCGCD Water Use Report

Fayette County Groundwater Conservation District

WATER USE REPORT

Please provide Amount of Water Used in Acre Feet below: