NeDNR SW Form 001 "Petition Requesting Leave to File or Consider an Application for a New Surface Water Appropriation Within a Moratorium or Stay Area Under Title 457 N.a.c. Chapter 23" - Nebraska

What Is NeDNR SW Form 001?

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

Form Details:

  • Released on March 1, 2018;
  • The latest edition provided by the Nebraska Department of Natural Resources (Surface Water);
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of NeDNR SW Form 001 by clicking the link below or browse more documents and templates provided by the Nebraska Department of Natural Resources (Surface Water).

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Download NeDNR SW Form 001 "Petition Requesting Leave to File or Consider an Application for a New Surface Water Appropriation Within a Moratorium or Stay Area Under Title 457 N.a.c. Chapter 23" - Nebraska

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NeDNR SW-001
STATE OF NEBRASKA
March 2018
DEPARTMENT OF NATURAL RESOURCES
PETITION REQUESTING LEAVE TO FILE OR CONSIDER AN APPLICATION FOR
A NEW SURFACE WATER APPROPRIATION WITHIN A MORATORIUM OR STAY AREA
UNDER TITLE 457 N.A.C. CHAPTER 23
FOR DEPARTMENT USE ONLY
Instructions:
1. Complete items 1 through 5 by printing in ink or typing the appropriate information
Filed in the office of the Department of Natural Resources
and by placing an X in the appropriate box.
at ____:____ on ________________________, 20____
2. Attach a copy of the completed proposed application for a new surface
Modification VAR-_______________________________
water appropriation.
3. Attach any supporting documentation.
SW Application: _______________ RightID:__________
4. Include a $10 non-refundable filing fee.
Water Division: _________________________________
Receipt Number: _____________ Amount: $__________
1. Name and contact information of petitioner:
Name:__________________________________________________________________________________________________________
Address 1:_______________________________________________________________________________________________________
Address 2:_______________________________________________________________________________________________________
City & State:_____________________________________________________________________________________________________
Zip Code:____________________________________________________________________ Phone Number: (
)______-_________
E-Mail Address:_______________________________________________________________
Cell Phone: (
)______-_________
2. Check the situation that applies:
Application already filed. Application Number: ______________________________
Application not filed. (Enclose copy of proposed application)
3. Description of proposed project:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
4. The proposed project must meet at least one of the following criteria. (Check all that apply)
1. The proposed project is for a non-consumptive use. (Attach description of use)
2. The applicant has a credible proposal for replacing any consumptive use that will occur in a manner such that the project will
not harm other users. (Attach offset plan)
3. The Applicant has credible information that indicates there may be unappropriated water available at the proposed location at
the time the depletion is likely to occur. (Attach analysis)
4. The project existed prior to any informal moratorium, formal moratorium or stay. (Attach proof)
5. There is a public safety issue that must be addressed and the proposed project addresses that issue. (Attach explanation)
6. The proposed use is a temporary use for public construction and the total volume requested is less than ten (10) acre-feet.
5. Other reason(s) to show good cause why a variance should be granted:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_______________
___________________________________________
_______________________________________________
Date
Signature of Petitioner (or authorized agent)
Print Name
If you have any questions regarding this form, please contact the Surface Water Permitting Section at the Department of Natural Resources (402) 471-2363
Forward this petition, all supplemental documentation and a $10 non-refundable filing fee to:
State of Nebraska
Department of Natural Resources
301 Centennial Mall South
P.O. Box 94676
Lincoln, Nebraska, 68509-4676
NeDNR SW-001
STATE OF NEBRASKA
March 2018
DEPARTMENT OF NATURAL RESOURCES
PETITION REQUESTING LEAVE TO FILE OR CONSIDER AN APPLICATION FOR
A NEW SURFACE WATER APPROPRIATION WITHIN A MORATORIUM OR STAY AREA
UNDER TITLE 457 N.A.C. CHAPTER 23
FOR DEPARTMENT USE ONLY
Instructions:
1. Complete items 1 through 5 by printing in ink or typing the appropriate information
Filed in the office of the Department of Natural Resources
and by placing an X in the appropriate box.
at ____:____ on ________________________, 20____
2. Attach a copy of the completed proposed application for a new surface
Modification VAR-_______________________________
water appropriation.
3. Attach any supporting documentation.
SW Application: _______________ RightID:__________
4. Include a $10 non-refundable filing fee.
Water Division: _________________________________
Receipt Number: _____________ Amount: $__________
1. Name and contact information of petitioner:
Name:__________________________________________________________________________________________________________
Address 1:_______________________________________________________________________________________________________
Address 2:_______________________________________________________________________________________________________
City & State:_____________________________________________________________________________________________________
Zip Code:____________________________________________________________________ Phone Number: (
)______-_________
E-Mail Address:_______________________________________________________________
Cell Phone: (
)______-_________
2. Check the situation that applies:
Application already filed. Application Number: ______________________________
Application not filed. (Enclose copy of proposed application)
3. Description of proposed project:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
4. The proposed project must meet at least one of the following criteria. (Check all that apply)
1. The proposed project is for a non-consumptive use. (Attach description of use)
2. The applicant has a credible proposal for replacing any consumptive use that will occur in a manner such that the project will
not harm other users. (Attach offset plan)
3. The Applicant has credible information that indicates there may be unappropriated water available at the proposed location at
the time the depletion is likely to occur. (Attach analysis)
4. The project existed prior to any informal moratorium, formal moratorium or stay. (Attach proof)
5. There is a public safety issue that must be addressed and the proposed project addresses that issue. (Attach explanation)
6. The proposed use is a temporary use for public construction and the total volume requested is less than ten (10) acre-feet.
5. Other reason(s) to show good cause why a variance should be granted:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_______________
___________________________________________
_______________________________________________
Date
Signature of Petitioner (or authorized agent)
Print Name
If you have any questions regarding this form, please contact the Surface Water Permitting Section at the Department of Natural Resources (402) 471-2363
Forward this petition, all supplemental documentation and a $10 non-refundable filing fee to:
State of Nebraska
Department of Natural Resources
301 Centennial Mall South
P.O. Box 94676
Lincoln, Nebraska, 68509-4676