Form DWR4 "Application for Approval of Plans and Specifications for the Repair or Alternation of a Dam and Reservoir" - California

What Is Form DWR4?

This is a legal form that was released by the California Department of Water Resources - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2021;
  • The latest edition provided by the California Department of Water Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DWR4 by clicking the link below or browse more documents and templates provided by the California Department of Water Resources.

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Download Form DWR4 "Application for Approval of Plans and Specifications for the Repair or Alternation of a Dam and Reservoir" - California

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State of California
DEPARTMENT OF WATER RESOURCES
California Natural Resources Agency
Division of Safety of Dams
APPLICATION FOR APPROVAL OF PLANS AND SPECIFICATIONS FOR THE
REPAIR OR ALTERATION OF A DAM AND RESERVOIR
DSOD Office Use Only
Dam Number
Application Filed
Applicant must NOT fill in the above blanks.
For additional information concerning the filling out and filing of this form, refer to Part 1, Division 3 of the California Water
Code and Chapter 1, Division 2, Title 23 of the California Code of Regulations. This is not an application to appropriate water.
To secure the right to appropriate water, application should be made to the State Water Resources Control Board on forms
the Board will provide upon request.
I,
of
.
Name of individual signing application
Address
County of
, State of
, hereby make application for the
approval of plans and specifications for the
repair
alteration of
Name of dam and reservoir
dam and reservoir.
The owner of the dam and reservoir is
Name of owner
of
County of
, State of
.
Address
If the owner is a corporation, give name and address of president and secretary:
The applicant is acting for the owner in the legal capacity of
.
Agent, Lessee, Trustee, Engineer, etc.
Location of Dam
(Enter the location of the dam’s upper right abutment contact or the center of the reservoir for tanks)
1.
The dam is located at Latitude
Longitude
Enter to 5 decimal places
Enter to 5 decimal places
and is located on
, tributary to
.
Creek, river or offstream
Creek or river
Description of Proposed Work
2.
Type of dam
Concrete arch or gravity, earthfill, rockfill, etc.
3.
Description of work proposed (Use extra sheets or exhibits if necessary.)
4.
Work will result in:
the maximum possible storage elevation.
“No change in” or “Lowering”
This form is not to be used if the alteration will increase the water storage elevation of the reservoir as previously operated.
5.
Estimated cost of work $
Initial filing fee will be based on this figure
6.
Work is to commence by
, and to be completed by
.
7.
Engineer
8. Contractor
9.
The maps, plans and specifications, and initial filing fee of $
associated this application
are a part thereof.
Signed:
Applicant
this
day of
, 20
DWR 4 (Rev. 1/21)
Page 1 of 2
State of California
DEPARTMENT OF WATER RESOURCES
California Natural Resources Agency
Division of Safety of Dams
APPLICATION FOR APPROVAL OF PLANS AND SPECIFICATIONS FOR THE
REPAIR OR ALTERATION OF A DAM AND RESERVOIR
DSOD Office Use Only
Dam Number
Application Filed
Applicant must NOT fill in the above blanks.
For additional information concerning the filling out and filing of this form, refer to Part 1, Division 3 of the California Water
Code and Chapter 1, Division 2, Title 23 of the California Code of Regulations. This is not an application to appropriate water.
To secure the right to appropriate water, application should be made to the State Water Resources Control Board on forms
the Board will provide upon request.
I,
of
.
Name of individual signing application
Address
County of
, State of
, hereby make application for the
approval of plans and specifications for the
repair
alteration of
Name of dam and reservoir
dam and reservoir.
The owner of the dam and reservoir is
Name of owner
of
County of
, State of
.
Address
If the owner is a corporation, give name and address of president and secretary:
The applicant is acting for the owner in the legal capacity of
.
Agent, Lessee, Trustee, Engineer, etc.
Location of Dam
(Enter the location of the dam’s upper right abutment contact or the center of the reservoir for tanks)
1.
The dam is located at Latitude
Longitude
Enter to 5 decimal places
Enter to 5 decimal places
and is located on
, tributary to
.
Creek, river or offstream
Creek or river
Description of Proposed Work
2.
Type of dam
Concrete arch or gravity, earthfill, rockfill, etc.
3.
Description of work proposed (Use extra sheets or exhibits if necessary.)
4.
Work will result in:
the maximum possible storage elevation.
“No change in” or “Lowering”
This form is not to be used if the alteration will increase the water storage elevation of the reservoir as previously operated.
5.
Estimated cost of work $
Initial filing fee will be based on this figure
6.
Work is to commence by
, and to be completed by
.
7.
Engineer
8. Contractor
9.
The maps, plans and specifications, and initial filing fee of $
associated this application
are a part thereof.
Signed:
Applicant
this
day of
, 20
DWR 4 (Rev. 1/21)
Page 1 of 2
APPLICATION FOR APPROVAL OF PLANS AND SPECIFICATIONS FOR THE
REPAIR OR ALTERATION OF A DAM AND RESERVOIR
DSOD Office Use Only (Applicant must NOT fill in the below blanks).
APPROVAL OF APPLICATION
filed
including the plans and specifications.
This is to certify that the application, including plans and specifications for the
repair
alteration of
dam and reservoir, No.
, has been examined and
the same is hereby approved, subject to the following terms and limitations:
1. Construction work shall be started within one year from the approval date of this application.
2. No foundations or abutments shall be covered by the material of the dam until the department has been given
an opportunity to inspect and approve the same.
Witness my hand and the seal of the Department of
Water Resources of the State of California
this
day of
, 20
Chief, Division of Safety of Dams
Registered Civil Engineer No.
DWR 4 (Rev. 1/21)
Page 2 of 2
Page of 2