Form 102-4070 "Application to Transfer a Certificate of Approval to Operate a Dam" - Alaska

What Is Form 102-4070?

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

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the Alaska Department of Natural 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 printable version of Form 102-4070 by clicking the link below or browse more documents and templates provided by the Alaska Department of Natural Resources.

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Download Form 102-4070 "Application to Transfer a Certificate of Approval to Operate a Dam" - Alaska

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DIVISION OF MINING, LAND & WATER
DAM SAFETY AND CONSTRUCTION UNIT
th
Office Use Only
550 West 7
Avenue, Suite 1020
Office Use Only
Comments
Anchorage, AK 99501-3562
Date/Time Stamp
(907) 269-8636
Fax: 269-8904
Office Use Only
Receipt Type: DM
APPLICATION TO TRANSFER A
CERTIFICATE OF APPROVAL TO OPERATE A DAM
Instructions:
Submit signed application form to above address
Include fee as indicated below
Attach copies of existing certificates of approval to operate a dam
Contact Dam Safety and Construction Unit for additional submittal requirements
Name of Dam:
AK No.
Certificate Holder:
Contact Name:
Position:
Address:
City:
State:
Zip:
Phone:
Fax:
Fee Attached [Multiply the number of certificates to be transferred by $300]
New Certificate Holder:
Contact Name:
Position:
Address:
City:
State:
Zip:
Phone:
Fax:
Authorized Representative of Existing Certificate Holder
Signed:
Date:
Authorized Representative of Proposed Certificate Holder
Signed:
Date:
102-4070, Rev. 6/18
(ATCOA 6/18)
Page 1 of 2
DIVISION OF MINING, LAND & WATER
DAM SAFETY AND CONSTRUCTION UNIT
th
Office Use Only
550 West 7
Avenue, Suite 1020
Office Use Only
Comments
Anchorage, AK 99501-3562
Date/Time Stamp
(907) 269-8636
Fax: 269-8904
Office Use Only
Receipt Type: DM
APPLICATION TO TRANSFER A
CERTIFICATE OF APPROVAL TO OPERATE A DAM
Instructions:
Submit signed application form to above address
Include fee as indicated below
Attach copies of existing certificates of approval to operate a dam
Contact Dam Safety and Construction Unit for additional submittal requirements
Name of Dam:
AK No.
Certificate Holder:
Contact Name:
Position:
Address:
City:
State:
Zip:
Phone:
Fax:
Fee Attached [Multiply the number of certificates to be transferred by $300]
New Certificate Holder:
Contact Name:
Position:
Address:
City:
State:
Zip:
Phone:
Fax:
Authorized Representative of Existing Certificate Holder
Signed:
Date:
Authorized Representative of Proposed Certificate Holder
Signed:
Date:
102-4070, Rev. 6/18
(ATCOA 6/18)
Page 1 of 2
AS 38.05.035(a) authorizes the director to decide what information is needed to process an application for the sale or use of state land and
resources. This information is made a part of the state public land records and becomes public information under AS 40.25.110 and 40.25.120
(unless the information qualifies for confidentiality under AS 38.05.035(a)(8) and confidentiality is requested, AS 43.05.230, or AS 45.48). Public
information is open to inspection by you or any member of the public. A person who is the subject of the information may challenge its
accuracy or completeness under AS 44.99.310, by giving a written description of the challenged information, the changes needed to correct it,
and a name and address where the person can be reached. False statements made in an application for a benefit are punishable under AS
11.56.210. In submitting this form, the applicant agrees with the Department to use “electronic” means to conduct “transactions” (as those
terms are used in the Uniform Electronic Transactions Act, AS 09.80.010 – AS 09.80.195) that relate to this form and that the Department need
not retain the original paper form of this record: the department may retain this record as an electronic record and destroy the original.
Page 2 of 2
(ATCOA 6/18)
102-4070, Rev. 6/18
Page of 2