Form 611 - Objection To Application
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3Form No. 611 U3/25/2016
OBJECTION TO APPLICATION
FILING FEE: $25.00
FOR DEPARTMENT USE ONLY
Use this form when objecting to an application for a water use permit,
Postmarked Date
______________________
change authorization or forest service water reservation.
Date Received
______________________
Rec'd By
______________________
Use one form for each application to which you are objecting. Individual
Fee Rec'd
______________________
water right owners must file separate objections.
Check No.
______________________
Refund
______________________
THIS FORM MUST BE RECEIVED OR POSTMARKED ON OR BEFORE THE
DEADLINE SPECIFIED IN THE PUBLIC NOTICE.
Permit
Change
Water Reservation
Temporary Lease
Submit form and filing fee to:
Montana Department of Natural Resources and Conservation
Obj #
__________________________
Reviewed by
__________________________
1424 9th Avenue, PO Box 201601, Helena, MT 59620-1601
Date
__________________________
1. NAME OF OBJECTOR ________________________________________________________________________
Mailing Address ______________________________________________________________________________
City _____________________________________________
State ___________
Zip
______________
Home Phone _______________________________________ Other Phone _____________________________
2. TO WHAT APPLICATION ARE YOU OBJECTING?
Number ________________________________________
Applicant Name _______________________________________________________________________________
3. HOW DO YOU HAVE STANDING TO FILE THIS OBJECTION? - A person has standing if his or her property,
water rights, or interests would be adversely affected by the proposed appropriation. Explain your interest and how it
would be adversely affected.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
4. WILL YOUR WATER RIGHT BE AFFECTED? If so, provide the water right number.
(W)
Statement of Claim No. ________________________________________________________________
(P)
Permit to Appropriate Water No. __________________________________________________________
(C)
Certificate of Water Right No.
__________________________________________________________
(D)
Powder River Final Decree No. __________________________________________________________
(M/R) Reservation of Water No.
__________________________________________________________
(E)
Exempt Water Right No. ________________________________________________________________
(F)
Non-recorded Exempt Right (For a filing not on record with the DNRC, complete the information below).
ype of Use
Stock
Domestic
Date of First Use ______________________________
T
Groundwater (For example, well or developed spring)
Instream Surface water Source _______________________________________________________
Amount Used
Flow Rate ___________ Gallons Per Minute
Volume __________ Acre-Feet
Point of Diversion ____1/4 ____1/4 ____1/4 Section ____, Twp _____
N
S, Rge _____
E
W
County ________________________________________________
Lot/Tract ___________ Block__________ Subdivision Name__________________________________
Objection to Application
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