Addition To Exemption Application Watershed Dam Or Reservoir printable pdf download

Addition To Exemption Application Watershed Dam Or Reservoir

Addition to Exemption

KSA 79-201g

Page 1 of 1

Applicant Name: ________________________

Docket No. _____________________________

Addition to Exemption Application

Watershed Dam or Reservoir

K.S.A. 79-201g

Provide a complete copy of the Certificate of Completion of Dam and all attachments from the

Division of Water Resources.

Provide the legal description(s) of the real property owned by you which is contiguous to and a

part of the same tract of land upon which the dam or reservoir has been constructed.

VERIFICATION

I, ________________________________, do solemnly swear or affirm that the information set forth

herein is true and correct, to the best of my knowledge and belief. So help me God.

_____________________________________

Signature of Applicant

_____________________________________

Printed Name and Title

State of ____________________

)

County of __________________

)

This instrument was acknowledged before me on __________ by ______________________________.

Seal

_____________________________________

Signature of Notary Public

My appointment expires: ________________

Revised 7/14

Addition To Exemption Application Watershed Dam Or Reservoir