Water Request

OMB # 1076-0141

Expires: XX-XX-XXXX

WATER REQUEST

(AGENCY NAME)

(NAME) IRRIGATION PROJECT

(CITY, STATE)

REQUESTER’S NAME: ____________________________________________________________________________

DATE OF REQUEST: ___________________________ TIME OF REQUEST: ____________________________

UNIT NO.: _____________________________ SERIAL NO.: __________________________________________

LEGAL DESCRIPTION: __________________________________________

CANAL / LATERAL: __________________________ HEAD GATE: __________________________________

NUMBER OF ACRES TO IRRIGATE: ______________

TYPE OF CROP GROWN: __________________________________________________________________________

DIVERSION AMOUNT REQUESTED: _________________________________

TIME ON: _____________________________ DATE: _________________________

TIME OFF: _____________________________ DATE: _________________________

DITCH RIDER NAME:

REQUEST must be in at least 72 hours and not over 7 days prior to desired time of water delivery. WATER USERS must be responsible for water until returned to canal. Use one request for each turnout.

Paperwork Reduction Statement: This information is being collected to determine the consumer’s water needs and it will be used to determine when and where to deliver water. Response to this request is required to obtain irrigation water. Public reporting burden for this form is estimated to average 30 minutes per response. Direct comments regarding the burden estimate or any other aspect of this form to Attn: Information Collection Clearance Officer – Indian Affairs, 1849 C Street, NW, MS-4141, Washington, DC 20240. Note: comments, names and addresses of commentators is available for public review during regular business hours. If you wish us to withhold this information you must state this prominently at the beginning of your comment. We will honor your request to the extent allowable by law. A federal agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The number and expiration date are displayed in the upper right corner of the form.