Form 607 - Application For Extension Of Time 2013
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1
2Form No. 607 U01/13
APPLICATION FOR
EXTENSION OF TIME
To Complete a Permit to Appropriate Water or
FOR DEPARTMENT USE ONLY
Authorization to Change Appropriation Water Right
Permit or Change No. _________________ _______________
Date Received
________________________________
IMPORTANT
Time
_________________________AM - PM
All requests for extension of time must be filed with the
Rec'd By
_______________________________________
Department by December 31st of the year specified for
Fee Rec'd $ ____________
Check No. _____________
completion. Attach the filing fee and submit to your local
Deposit Receipt # __________________________________
Water Resources Regional Office.
Payor (if different from name(s) listed in item 1 below)
__________________________________________________
Filing Fee $200.00
Refund $
______________
Date __________________
1. Name ____________________________________________________________________________________________
Mailing address _____________________________________________________________________________________
City or Town _______________________________________ State
_____________ Zip
____________________
Home Phone ___________________
Work Phone ____________________
Cell Phone
____________________
Check if name or address is different than on the Permit or Authorization to Change.
2.
Permit or
Authorization No(s): _______________________________________________________________
County: ________________________________
Date Notice of Completion is due:
___________________________
Number of previous extensions granted: __________________
Additional years requested to complete the project: ______________________
3. Why wasn't this project completed as scheduled?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
4. Chronologically, describe what has been completed on this project? Enclose photographs, receipts, contacts for
design or construction, maps, or other information to show what work has been completed.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
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