HomeMy WebLinkAboutRFI19-0444-A018413_envformDRAFTPage 1 of 4
State of California
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
ENVIRONMENTAL INFORMATION FOR PETITIONS
This form is required for all petitions.
Before the State Water Resources Control Board (State Water Board) can approve a petition, the State Water
Board must consider the information contained in an environmental document prepared in compliance with the
California Environmental Quality Act (CEQA). This form is not a CEQA document. If a CEQA document has
not yet been prepared, a determination must be made of who is responsible for its preparation. As the
petitioner, you are responsible for all costs associated with the environmental evaluation and preparation of the
required CEQA documents. Please answer the following questions to the best of your ability and submit any
studies that have been conducted regarding the environmental evaluation of your project. If you need more
space to completely answer the questions, please number and attach additional sheets.
DESCRIPTION OF PROPOSED CHANGES OR WORK REMAINING TO BE COMPLETED
For a petition for change, provide a description of the proposed changes to your project including, but not limited
to, type of construction activity, structures existing or to be built, area to be graded or excavated, increase in
water diversion and use (up to the amount authorized by the permit), changes in land use, and project
operational changes, including changes in how the water will be used. For a petition for extension of time,
provide a description of what work has been completed and what remains to be done. Include in your
description any of the above elements that will occur during the requested extension period.
Insert the attachment number here, if applicable:
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Coordination with Regional Water Quality Control Board
For change petitions only, you must request consultation with the Regional Date of Request
Water Quality Control Board regarding the potential effects of your proposed
change on water quality and other instream beneficial uses. (Cal. Code Regs.,
tit. 23, § 794.) In order to determine the appropriate office for consultation, see:
http://www.waterboards.ca.gov/waterboards_map.shtml. Provide the
date you submitted your request for consultation here, then provide the following
information.
Will your project, during construction or operation, (1) generate waste or
wastewater containing such things as sewage, industrial chemicals, metals, Yes No
or agricultural chemicals, or (2) cause erosion, turbidity or sedimentation?
Will a waste discharge permit be required for the project? Yes No
If necessary, provide additional information below:
Insert the attachment number here, if applicable:
Local Permits
For temporary transfers only, you must contact the board of supervisors for the Date of Contact
county(ies) both for where you currently store or use water and where you propose
to transfer the water. (Wat. Code § 1726.) Provide the date you submitted
your request for consultation here.
For change petitions only, you should contact your local planning or public works department and provide the
information below.
Person Contacted: Date of Contact:
Department: Phone Number:
County Zoning Designation:
Are any county permits required for your project? If yes, indicate type below. Yes No
Grading Permit Use Permit Watercourse Obstruction Permit
Change of Zoning General Plan Change Other (explain below)
If applicable, have you obtained any of the permits listed above? If yes, provide copies. Yes No
If necessary, provide additional information below:
Insert the attachment number here, if applicable:
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Federal and State Permits
Check any additional agencies that may require permits or other approvals for your project:
Regional Water Quality Control Board Department of Fish and Game
Dept of Water Resources, Division of Safety of Dams California Coastal Commission
State Reclamation Board U.S. Army Corps of Engineers U.S. Forest Service
Bureau of Land Management Federal Energy Regulatory Commission
Natural Resources Conservation Service
Have you obtained any of the permits listed above? If yes, provide copies. Yes No
For each agency from which a permit is required, provide the following information:
Agency Permit Type Person(s) Contacted Contact Date Phone Number
If necessary, provide additional information below:
Insert the attachment number here, if applicable:
Construction or Grading Activity
Does the project involve any construction or grading-related activity that has significantly Yes No
altered or would significantly alter the bed, bank or riparian habitat of any stream or lake?
If necessary, provide additional information below:
Insert the attachment number here, if applicable:
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Archeology
Has an archeological report been prepared for this project? If yes, provide a copy. Yes No
Will another public agency be preparing an archeological report? Yes No
Do you know of any archeological or historic sites in the area? If yes, explain below. Yes No
If necessary, provide additional information below:
Insert the attachment number here, if applicable:
Photographs
For all petitions other than time extensions, attach complete sets of color photographs, clearly dated and
labeled, showing the vegetation that exists at the following three locations:
Along the stream channel immediately downstream from each point of diversion
Along the stream channel immediately upstream from each point of diversion
At the place where water subject to this water right will be used
Maps
For all petitions other than time extensions, attach maps labeled in accordance with the regulations showing all
applicable features, both present and proposed, including but not limited to: point of diversion, point of
rediversion, distribution of storage reservoirs, point of discharge of treated wastewater, place of use, and
location of instream flow dedication reach. (Cal. Code Regs., tit. 23, §§ 715 et seq., 794.)
Pursuant to California Code of Regulations, title 23, section 794, petitions for change submitted without maps
may not be accepted.
All Water Right Holders Must Sign This Form:
I (we) hereby certify that the statements I (we) have furnished above and in the attachments are complete to
the best of my (our) ability and that the facts, statements, and information presented are true and correct to the
best of my (our) knowledge. Dated at .
__________________________________________ __________________________________________
Water Right Holder or Authorized Agent Signature Water Right Holder or Authorized Agent Signature
NOTE:
Petitions for Change may not be accepted unless you include proof that a copy of the petition was served on the
Department of Fish and Game. (Cal. Code Regs., tit. 23, § 794.)
Petitions for Temporary Transfer may not be accepted unless you include proof that a copy of the petition was served
on the Department of Fish and Game and the board of supervisors for the county(ies) where you currently store or use
water and the county(ies) where you propose to transfer the water. (Wat. Code § 1726.)