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5. ATTACHMENTS

Check each of the following attachments included with this application. The

application will be returned if all required attachments are not included.

Supplemental Form A –

Supplemental Water Right Statement

A written statement, if applicable, identifying

Description of Proposed Change(s) to a

supplemental water rights that will not be

Water Right

transferred, but remain unexercised at the

A separate Supplemental Form A is enclosed for

authorized place of use during the irrigation season.

each water right to be affected by this transfer.

Water Well Reports/Well Logs:

Map

The application is for a change from surface water to

Temporary Transfer

ground water and copies of all water well reports are

A map meeting the requirements of OAR 690-385-

attached.

3300 must be included but need not be prepared by

Water well reports are not available and attached is a

a Certified Water Right Examiner.

description of construction details including well

Consent to Transfer

depth, static water level, and information necessary

to establish the ground water body developed or

A c

opy of the written consent, if applicable, for a

proposed to be developed.

change in type of use of a water right to store water.

The application is for a surface water transfer and

Land Use Compatibility Statement

water well reports are not required.

Fees:

The Land Use Information Form is not required if

water is to be diverted, conveyed and/or used only on

Amount enclosed: $

federal lands or if ALL of the following apply: a) a

See the Department’s Fee Schedule at

change in place of use only, b) a change that does not

or call (503) 986-0900.

involve the placement or modification of structures,

c) the use of water is for irrigation only and d) the use

is located within an irrigation district or an exclusive

farm use zone.

6.SIGNATURES

The district certifies the following:

(1) The water right(s) proposed for transfer is a water right(s) subject to transfer and has not been

forfeited for nonuse under ORS 540.610;

(2) Each user affected by the proposed transfer has provided written authorization for the transfer and

such authorization is on file with the district; and

(3) The district has notified each affected user that the Department may condition or reject the transfer

at any time to the extent necessary too avoid injury to an existing water right, and that the use of

water on lands from which the water right is transferred (authorized place of use) and at the

proposed place of use during the same irrigation season or calendar year may subject both the user

and district to civil penalties.

On behalf of the district, I affirm that the information contained in this application is true and accurate.

______________________________

_________________________

_____________

District Manager signature

name (print)

date

______________________________

_________________________

_____________

Authorized District Representative signature

name (print)

date

Before submitting your application to the Department, be sure you have:



Answered each question completely.



Included all the required attachments.



Included a check payable to the Oregon Water Resources Department for the appropriate amount.

Last Revised March 2015

District Temporary Transfer Application

Page 3 of 3

Application For District Temporary Water Right Form - Oregon Water Resources Department Page 3

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