Water Request

Water Request, 25 CFR 171

Water Request Form

Request for Irrigation Service (individual)

OMB: 1076-0141

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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.


File Typeapplication/msword
File TitleOMB # 1076-0141
AuthorIndian Affairs User
Last Modified ByAmanda
File Modified2012-12-18
File Created2012-12-18

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