Form Tceq-20425 Application For A Temporary Water Use Permit For Up To 10 Acre-Feet Of Water And Up To One Calendar Year printable pdf download

TEXAS COMMISSION ON ENVIRONMENTAL QUALITY

APPLICATION FOR A TEMPORARY WATER USE PERMIT FOR UP TO 10 ACRE-FEET OF WATER AND UP TO ONE CALENDAR YEAR

This form is for an application for a temporary permit to divert water under Section 11.138, Texas Water Code. Any permit granted from

this application may be suspended

at any time by the applicable TCEQ Office if it determined that surplus water is no longer available.

Please submit the application to the appropriate Regional or Watermaster office. This application must be accompanied with the TCEQ Core

Data Form (TCEQ -10400).

Notice: This form will not be processed until all delinquent fees and/or penalties owed to the TCEQ or the Office of the

Attorney General on behalf of the TCEQ are paid in accordance with the Delinquent Fee and Penalty Protocol.

Data on Applicant and Project:

Name ___________________________________________________________________________________________________

Mailing Address

__________________________________________________________________________________________

Telephone Number ______________________________________

Fax Number _____________________________________

Applicant owes fees or penalties?

Yes

If yes, provide the amount and the nature of the fee or penalty as well as any identifying number:

________________________________________________________________________________________________________

Describe Use of Water ______________________________________________________________________________________

Location of Use ____________________________________________________________________________________________

Description of Project (TDH Project No. if applicable) ______________________________________________________________

Highway Designation No. ____________________________________ County _________________________________________

Type of Diversion (check one):

3. Rate of Diversion:

From Stream

From Reservoir

A. Maximum __________________ gpm

(capacity of pump)

Amount and Source of Water:

__________________ acre-feet of water within a period of ______________ (specify term period not to exceed a one year term). The

water is to be obtained from _________________________, tributary of _____________________, tributary of ________________,

tributary of _________________, ____________________________ Basin.

Location of Diversion Point:

At Latitude _______________ ºN, Longitude ______________ ºW, ((at) or (near) the stream crossing of), (at a reservoir in the

vicinity of) ______________ (R-O-W) (Highway), located _______ miles in a _____________ direction from _____________________

(County Seat), _____________ County, and ________ miles in a _______________ direction from ___________________, a nearby

town shown on County road map. Note: Distance in straight line miles.

Enclose a topographic map or vicinity map on letter size paper or larger with sufficient information to enable the Commission Staff to

locate on the ground the diversion site, the location of use, and the return water discharge points, if any. A portion of a county road

map would suffice. Owner’s written consent is required for water used from any private reservoir, or private access to diversion point.

Depending on the scope and location of the project, a measuring device may be required in areas under Watermaster jurisdiction in

accordance with §303.11(e) and §304.13.

Access to Diversion Point (check one):

7. Fees Enclosed:

Public right-of-way

Filing ………………………………………………………….

$100.00

Private Property

Recording ………………………………………………….

1.25

(A letter of permission from landowner is attached)

Use ($1.00 per ac-ft or fraction thereof)

$______

Other (Explain)

(Note: 1 ac-ft = 325,851 gals.

Total

$______

1 ac-ft = 7758.35 bbls.)

Upon completion of any project for which a temporary water permit is granted, the Permittee is required by law to report the amount of

water used. This document must be properly signed and duly notarized before it can be accepted or considered by the Texas

Commission on Environmental Quality.

__________________________________________

___________________________________________

Name (sign)

Name (print)

Subscribed and sworn to me as being true and correct before me this ______ day of ______________, 201__.

___________________________________________

Notary Public, State of Texas

Form TCEQ-20425 (revised 11/10)

Form Tceq-20425 Application For A Temporary Water Use Permit For Up To 10 Acre-Feet Of Water And Up To One Calendar Year

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