HomeMy WebLinkAboutRFI19-0444-A009514_pet_changeDRAFTMAIL FORM AND ATTACHMENTS TO:
State Water Resources Control Board
DIVISION OF WATER RIGHTS
P.O. Box 2000, Sacramento, CA 95812-2000
Tel: (916) 341-5300 Fax: (916) 341-5400
http://www.waterboards.ca.gov/waterrights
PETITION FOR CHANGE
Separate petitions are required for each water right. Mark all areas that apply to your proposed change(s). Incomplete
forms may not be accepted. Location and area information must be provided on maps in accordance with established
requirements. (Cal. Code Regs., tit. 23, § 715 et seq.) Provide attachments if necessary.
Point of Diversion Point of Rediversion Place of Use Purpose of Use
Wat. Code, § 1701 Cal. Code Regs., tit. 23, § 791(e) Wat. Code, § 1701 Wat. Code, § 1701
Distribution of Storage Temporary Urgency Instream Flow Dedication Waste Water
Cal. Code Regs., tit. 23, § 791(e) Wat. Code, § 1435 Wat. Code, § 1707 Wat. Code, § 1211
Split Terms or Conditions Other
Cal. Code Regs., tit. 23, § 836 Cal. Code Regs., tit. 23, § 791(e)
Application Permit License Statement
I (we) hereby petition for change(s) noted above and described as follows:
Point of Diversion or Rediversion – Provide source name and identify points using both Public Land Survey System descriptions
to ¼-¼ level and California Coordinate System (NAD 83).
Present:
Proposed:
Place of Use – Identify area using Public Land Survey System descriptions to ¼-¼ level; for irrigation, list number of acres irrigated.
Present:
Proposed:
Purpose of Use
Present:
Proposed:
Split
Provide the names, addresses, and phone numbers for all proposed water right holders.
In addition, provide a separate sheet with a table describing how the water right will be split between the water right
holders: for each party list amount by direct diversion and/or storage, season of diversion, maximum annual amount,
maximum diversion to offstream storage, point(s) of diversion, place(s) of use, and purpose(s) of use. Maps showing the
point(s) of diversion and place of use for each party should be provided.
Distribution of Storage
Present:
Proposed:
Please indicate County where
your project is located here:
VHHLQVWUHDPIORZGHGLFDWLRQVHFWLRQRQSDJHDQGDWWDFKHGPDSIRUIXOOH[WHQW
Butte
A009514 005369 003736
within SE1/4 of NE1/4 of Section 7, T21N, R6E, MDB&M
instream flow dedication reach starting at N 2,380,387ft, E 6,753,559ft.and N 2,380,907ft, E 6,754,009 ft. CCS NAD 83, Zone 2, being within NW1/4 of
NW1/4 of Section 9, T26N, R14E, MDB&M.
domestic and fire protection uses
fish and wildlife preservation and enhancement
Temporary Urgency
This temporary urgency change will be effective from to .
Include an attachment that describes the urgent need that is the basis of the temporary urgency change and whether the
change will result in injury to any lawful user of water or have unreasonable effects on fish, wildlife or instream uses.
Instream Flow Dedication – Provide source name and identify points using both Public Land Survey System descriptions to ¼-¼
level and California Coordinate System (NAD 83).
Upstream Location:
Downstream Location:
List the quantities dedicated to instream flow in either: cubic feet per second or gallons per day:
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Will the dedicated flow be diverted for consumptive use at a downstream location? Yes No
If yes, provide the source name, location coordinates, and the quantities of flow that will be diverted from the stream.
Waste Water
If applicable, provide the reduction in amount of treated waste water discharged in cubic feet per second.
Will this change involve water provided by a water service contract which prohibits Yes No
your exclusive right to this treated waste water?
Will any legal user of the treated waste water discharged be affected? Yes No
General Information – For all Petitions, provide the following information, if applicable to your proposed change(s).
Will any current Point of Diversion, Point of Storage, or Place of Use be abandoned? Yes No
I (we) have access to the proposed point of diversion or control the proposed place of use by virtue of:
ownership lease verbal agreement written agreement
If by lease or agreement, state name and address of person(s) from whom access has been obtained.
Give name and address of any person(s) taking water from the stream between the present point of diversion or
rediversion and the proposed point of diversion or rediversion, as well as any other person(s) known to you who may be
affected by the proposed change.
All Right Holders Must Sign This Form: I (we) declare under penalty of perjury that this change does not involve an
increase in the amount of the appropriation or the season of diversion, and that the above is true and correct to the best of
my (our) knowledge and belief. Dated at .
______________________________________________ ______________________________________________
Right Holder or Authorized Agent Signature Right Holder or Authorized Agent Signature
NOTE: All petitions must be accompanied by:
(1) the form Environmental Information for Petitions, including required attachments, available at:
http://www.waterboards.ca.gov/waterrights/publications_forms/forms/docs/pet_info.pdf
(2) Division of Water Rights fee, per the Water Rights Fee Schedule, available at:
http://www.waterboards.ca.gov/waterrights/water_issues/programs/fees/
(3) Department of Fish and Wildlife fee of $850 (Pub. Resources Code, § 10005)
N 2,380,387ft, E 6,753,559ft. and N 2,380,907ft, E 6,754,009 ft. CCS NAD 83, Zone 2, being within NW1/4 of NW1/4 of Section 9, T26N,
R14E, MDB&M.
N 2,352,995ft, E 6,761,067ft. CCS NAD 83, Zone 2, being within SW1/4 of NW1/4 of Section 3, T20N, R6E, MDB&M.
30,000 30,000 30,000 30,000 30,000 30,000 30,000 30,000 30,000 30,000 30,00030,000