Water Well Permit Application

400 S. OHIO AVE., MERCEDES, TEXAS 78570
(956) 565-3114 EXT. 128-129-143
EMAIL: PLANNING@CITYOFMERCEDES.COM
(PLEASE TYPE OR PRINT IN BLACK OR BLUE INK

AS REQUIRED UNDER THE CITY OF MERCEDES CODE OF ORDINANCES, ORDINANCE NO. 2025-33.
PURSUANT TO SECTION III OF ORDINANCE NO. 2025-33, ALL EXISTING AND NEW PRIVATE WATER
WELLS WITHIN THE CITY LIMITS MUST BE REGISTERED WITH THE CITY OF MERCEDES

Section 1:

Applicant

Name of Applicant

Address

City

State

Phone Number

Email

Section 2:

Well Specification & Usage

Date Well was Built/Installed

Is this an existing Well established prior to December 2, 2025?

Yes (See Fee Waiver note below)

No

What is the Water currently used for?

Irrigation/Landscaping

Livestock

Other Non-Potable use

Is the Water Well connected to the house or indoor plumbing?

Yes

No

Is the property connect with the City's public water?

Yes

No

NOTE: TO ENSURE COMPLIANCE WITH STATE AND CITY SAFETY STANDARDS, ANY CONNECTION THAT MAY CREATE A CROSS-CONNECTION WILL
REQUIRE A BACKFLOW.

Is the Well physically separated from the potable water system to prevent back flow?

Yes

No

Depth of Water Well?

IMPORTANT NOTE REGARDING FEES: > WHILE THE ORDINANCE MANDATES A FIFTY DOLLAR ($50.00) ANNUAL
REGISTRATION RENEWAL FEE, THE CITY OF MERCEDES IS CURRENTLY WAIVING REGISTRATION FEES FOR EXISTING
WATER WELLS ESTABLISHED PRIOR TO THE FINAL ADOPTION OF THIS ORDINANCE. PLEASE CONFIRM YOUR WELL'S
ESTABLISHED DATE IN SECTION 2.

Owner's Signature

Clear

Date

Forms

Water Well Permit Application

Section 1:

Applicant

Section 2:

Well Specification & Usage