Form MO780-1761 "Application to Renew Safety Permit" - Missouri

What Is Form MO780-1761?

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

Form Details:

  • Released on April 1, 2011;
  • The latest edition provided by the Missouri 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 fillable version of Form MO780-1761 by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

ADVERTISEMENT
ADVERTISEMENT

Download Form MO780-1761 "Application to Renew Safety Permit" - Missouri

Download PDF

Fill PDF online

Rate (4.8 / 5) 73 votes
STATE OF MISSOURI
MISSOURI DEPARTMENT OF NATURAL RESOURCES
DAM AND RESERVOIR SAFETY
APPLICATION TO RENEW SAFETY PERMIT
PERMIT NO.
DATE
GENERAL INFORMATION
DAM OWNER
SOLE PROPRIETOR
PARTNERSHIP
CORPORATION
OWNER(S) NAME
ADDRESS
CITY
STATE
ZIP CODE
TELEPHONE NUMBER (REQUIRED)
NAME OF DAM
ID NUMBER
MO
COUNTY
LOCATION OF DAM AT CENTERLINE AT MAXIMUM SECTION
¼
¼
TOWNSHIP
NORTH
SECTION
RANGE
EAST
WEST
APPROXIMATE UTM COORDINATES
Meters North
Meters East
DAM HEIGHT
RESERVOIR AREA
PURPOSE OF DAM AND RESERVOIR
NAME OF PERSON FILLING OUT THIS APPLICATION (TYPE OR PRINT)
SIGNATURE
DESCRIBE THE MAINTENANCE AND OPERATION OF THE DAM DURING THE PAST FIVE YEARS:
NOTE: All trees and woody vegetation must be removed from the Spillway and the Embankment.
PLEASE SUBMIT TO:
Department of Natural Resources
Water Resources Center
Dam and Reservoir Safety
PO Box 250
Rolla, MO 65402
573/ 368-2175
MO 780-1761 (04-11)
STATE OF MISSOURI
MISSOURI DEPARTMENT OF NATURAL RESOURCES
DAM AND RESERVOIR SAFETY
APPLICATION TO RENEW SAFETY PERMIT
PERMIT NO.
DATE
GENERAL INFORMATION
DAM OWNER
SOLE PROPRIETOR
PARTNERSHIP
CORPORATION
OWNER(S) NAME
ADDRESS
CITY
STATE
ZIP CODE
TELEPHONE NUMBER (REQUIRED)
NAME OF DAM
ID NUMBER
MO
COUNTY
LOCATION OF DAM AT CENTERLINE AT MAXIMUM SECTION
¼
¼
TOWNSHIP
NORTH
SECTION
RANGE
EAST
WEST
APPROXIMATE UTM COORDINATES
Meters North
Meters East
DAM HEIGHT
RESERVOIR AREA
PURPOSE OF DAM AND RESERVOIR
NAME OF PERSON FILLING OUT THIS APPLICATION (TYPE OR PRINT)
SIGNATURE
DESCRIBE THE MAINTENANCE AND OPERATION OF THE DAM DURING THE PAST FIVE YEARS:
NOTE: All trees and woody vegetation must be removed from the Spillway and the Embankment.
PLEASE SUBMIT TO:
Department of Natural Resources
Water Resources Center
Dam and Reservoir Safety
PO Box 250
Rolla, MO 65402
573/ 368-2175
MO 780-1761 (04-11)