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* indicates a required field

2. Well Watch Program Form

   Please fill out and submit this form if you would like to sign up for the Well Watch Program. We will come out to your property twice a year to check the water level of your well. 

   By submitting this form, you authorize Lost Pines GCD to enter your property for water level measurements.

4. First Name*
5. Last Name*
7. Phone Number*
8. Email Address*
10. Mailing Address*
12. Mailing City*
13. Mailing State*
14. Mailing Zip Code*
16. If your well's physical address is different than your mailing address, please fill in below the Physical Well Address and Physical Well City. If left blank, we will assume you well is located at your mailing address.
18. Physical Well Address
19. Physical Well City
21. Well ID

    Do you have an assigned well ID number? If not, leave blank and we will assign one to you.

22. Comments

    Is there anything else you would like us to know?

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit