NeDNR Form 200-A Addendum to Application for a Temporary Change of Location of Use and to Change the Purpose of Appropriation to Augment the Flow in a Specific Stream Reach - Nebraska

NeDNR Form 200-A or the "Addendum To Application For A Temporary Change Of Location Of Use And To Change The Purpose Of Appropriation To Augment The Flow In A Specific Stream Reach" is a form issued by the Nebraska Department of Natural Resources.

A PDF of the latest NeDNR Form 200-A can be downloaded below or found on the Nebraska Department of Natural Resources Forms and Publications website.

ADVERTISEMENT
SW Form # 200-A
District 7-2010 MOD # _____________
STATE OF NEBRASKA
DEPARTMENT OF NATURAL RESOURCES
LANDOWNER CONSENT AND HISTORY OF USE FOR EACH TRACT
ADDENDUM TO
APPLICATION FOR A TEMPORARY CHANGE OF LOCATION OF USE AND TO CHANGE THE
PURPOSE OF APPROPRIATION TO AUGMENT THE FLOW IN A SPECIFIC STREAM REACH
W
A
I
H
B
I
D
, R
D
, P
P
A
I
D
,
HEN
PPROPRIATION
S
ELD
Y
RRIGATION
ISTRICT
ECLAMATION
ISTRICT
UBLIC
OWER
ND
RRIGATION
ISTRICT
M
I
C
, C
C
O
T
U.S. B
O
R
UTUAL
RRIGATION
OMPANY
ANAL
OMPANY
R
HE
UREAU
F
ECLAMATION
1.a.
List below the number of acres in each forty acre subdivision to which the appropriation is now or was appurtenant (see instruction
sheet) and which will be subject to this transfer. Attach aerial photography showing the location of land listed below:
¼
¼
¼
¼
NW
NE
SW
SE
.
.
SEC
TWP
RANGE
TOTALS
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
NW
NE
SW
SE
NW
NE
SW
SE
NW
NE
SW
SE
NW
NE
SW
SE
1.b.
The above listed land has been irrigated using: (Circle all that apply) A. Surface water B. Groundwater C. Other
Total:
2.
List the history* of water use for the last ten years for the tracts listed above:
Maximum Surface
Annual Surface
Attach additional history information if needed.
Water Diversion Rate
Water Volume
Year
IR Begin and End Dates
Acres Irrigated
Crop Type
(cfs or gpm)
(gallons or acre-feet)
*The Department may require additional information about the history of the project.
3.
Name and address of each mortgage holder, deed of trust holder or other equivalent security interest for land now under permit.
(pursuant to Neb. Rev. Stat. § 46-290(1)(b)(v))
(If more than one, please use DNR Form 962-4):
Name:
Address:
City:
State:
Zip Code:
Telephone Number:
(
)
Cell Phone: (
)
e-mail address:
4.
I/We
(print name(s) of landowner(s))
do hereby certify that I am/we are the owner(s) of the land listed above under surface water appropriation
I/We do hereby consent to a change in location and use of appropriation for the above portion of water appropriation as proposed
in the attached transfer application filed by the organization named on page 1 of this application, to which this page is an addendum.
I/We understand that this transfer does not relieve me/us from any past or future obligations for operation, maintenance and other
tolls, charges or assessments that may be due to the organization named on page 1 of this application.
Signatures of landowners
Date
Address
Date
Address
Page 1 of 1
SW Form # 200-A
District 7-2010 MOD # _____________
STATE OF NEBRASKA
DEPARTMENT OF NATURAL RESOURCES
LANDOWNER CONSENT AND HISTORY OF USE FOR EACH TRACT
ADDENDUM TO
APPLICATION FOR A TEMPORARY CHANGE OF LOCATION OF USE AND TO CHANGE THE
PURPOSE OF APPROPRIATION TO AUGMENT THE FLOW IN A SPECIFIC STREAM REACH
W
A
I
H
B
I
D
, R
D
, P
P
A
I
D
,
HEN
PPROPRIATION
S
ELD
Y
RRIGATION
ISTRICT
ECLAMATION
ISTRICT
UBLIC
OWER
ND
RRIGATION
ISTRICT
M
I
C
, C
C
O
T
U.S. B
O
R
UTUAL
RRIGATION
OMPANY
ANAL
OMPANY
R
HE
UREAU
F
ECLAMATION
1.a.
List below the number of acres in each forty acre subdivision to which the appropriation is now or was appurtenant (see instruction
sheet) and which will be subject to this transfer. Attach aerial photography showing the location of land listed below:
¼
¼
¼
¼
NW
NE
SW
SE
.
.
SEC
TWP
RANGE
TOTALS
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
¼
NW
NE
SW
SE
NW
NE
SW
SE
NW
NE
SW
SE
NW
NE
SW
SE
1.b.
The above listed land has been irrigated using: (Circle all that apply) A. Surface water B. Groundwater C. Other
Total:
2.
List the history* of water use for the last ten years for the tracts listed above:
Maximum Surface
Annual Surface
Attach additional history information if needed.
Water Diversion Rate
Water Volume
Year
IR Begin and End Dates
Acres Irrigated
Crop Type
(cfs or gpm)
(gallons or acre-feet)
*The Department may require additional information about the history of the project.
3.
Name and address of each mortgage holder, deed of trust holder or other equivalent security interest for land now under permit.
(pursuant to Neb. Rev. Stat. § 46-290(1)(b)(v))
(If more than one, please use DNR Form 962-4):
Name:
Address:
City:
State:
Zip Code:
Telephone Number:
(
)
Cell Phone: (
)
e-mail address:
4.
I/We
(print name(s) of landowner(s))
do hereby certify that I am/we are the owner(s) of the land listed above under surface water appropriation
I/We do hereby consent to a change in location and use of appropriation for the above portion of water appropriation as proposed
in the attached transfer application filed by the organization named on page 1 of this application, to which this page is an addendum.
I/We understand that this transfer does not relieve me/us from any past or future obligations for operation, maintenance and other
tolls, charges or assessments that may be due to the organization named on page 1 of this application.
Signatures of landowners
Date
Address
Date
Address
Page 1 of 1

Download NeDNR Form 200-A Addendum to Application for a Temporary Change of Location of Use and to Change the Purpose of Appropriation to Augment the Flow in a Specific Stream Reach - Nebraska

892 times
Rate
4.4(4.4 / 5) 45 votes
ADVERTISEMENT