Form 600 - Application For Beneficial Water Use Permit - 2001
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4Form No. 600 R2/01
APPLICATION FOR BENEFICIAL
WATER USE PERMIT
Use for groundwater in excess of 35 GPM or 10 Acre-Feet
per year and all surface water.
INSTRUCTIONS
FOR DEPARTMENT USE ONLY
Use one application for each source of supply or each development. Check all appropriate
boxes and fill in each blank. If more space is needed, attach additional sheets. The information
Application No. __________________ Basin ________
required in the Form 600 A or B Criteria Addendum must be submitted with this
Priority Date __________________________________
application.
Time _________________________________ AM / PM
Complete the application and submit it with the filing fee, payable to DNRC, to the Water Resources
Rec'd By _____________________________________
Regional Office nearest you. Their addresses are listed on the back. The estimated processing
time after an application is correct and complete is 210 days.
Fee Rec'd $ ___________________________________
Check No. ____________________________________
Refund __________________ Date _______________
FILING FEE: $200.00
1.
NAME OF APPLICANT ______________________________________________________________________________________________
Mailing address _____________________________________________________________________________________________________
City __________________________________________________________________ State ___________ Zip ________________________
Phone: Home
Other
E-mail address
2.
SOURCE OF WATER SUPPLY
Well
Estimated Depth in Feet
Developed Spring
Name
Lake Name
Tributary to
Stream Name ____________________________________________________________________________________________________
Unnamed Source - Tributary to ______________________________________________________________________________________
Closed Basin (A closed basin results when water drains into a depression, lake, etc. from which water escapes only by evaporation.)
Other _________________________________________________
3.
POINT OF DIVERSION (Describe the location to the nearest 10 acres)
(1)
1/4
1/4
1/4 Section
Township
N/S Range
E/W
County
Lot
Block
Tract No.
Subdivision Name
Government Lot
(2)
1/4
1/4
1/4 Section
Township
N/S Range
E/W
County
Lot
Block
Tract No.
Subdivision Name
Government Lot
4.
MEANS OF DIVERSION
Headgate
Pump
Pipeline _____________________________________ Size
_____________ Rated Capacity (GPM or CFS)
Dam (Complete item 5)
_____________ Horsepower
Pit (Complete item 5)
_____________ Lift in Feet
Other ___________________________________________
Describe your plans, if any, for measuring your water use: __________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
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