2018 Fee Waiver Request Form

Please complete the following form using the information found on your invoice. By submitting this completed form, you are stating the water is not accessible to your lake property and requesting Brazos River Authority to waive the current year's annual fees for the permit listed below. Pictures of your lake property (commercial dock facility, pipes at diversion point, etc.) may be submitted with this form to your local BRA office as supporting documents of your request for waiver.

For the waiver to be approved, the water must be inaccessible to your lake property for at least 90 consecutive days of the year following the date of the waiver request; therefore, this request must be filed by October 2nd to be applied to the current calendar year's invoice. If lake levels rise and your property is accessible to water within the 90 day period, the waiver request will be voided and it will be the responsibility of the permit holder to file another request if the water level drops to a level that again restricts access to your lake property.

Customer No:

Permit Number (Item no. on Invoice):

Permit Type:

Facility Type:

Customer Name:

Physical Street Address of facility/pump:

Mailing Address:

Daytime Phone (e.g.: 2547613100):

Email Address (to receive waiver status notices):


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Optional: Upload Photo (file must be .jpg, .jpeg, .png, .gif, or .pdf and smaller than 10 MB):

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