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BEFORE THE STATE ENGINEER OF THE STATE OF NEVADA
APPLICATION FOR EXTENSION OF TIME FOR FILING PROOF OF COMPLETION OF WORK
1. This application is submitted by: , the Permittee Agent
Name of person signing this form
2. Permit number: Priority date:
3. Source: Underground Surface Water: name of the spring, creek, river, etc.
4. Current owner(s) of record in the Nevada Division of Water Resources (NDWR):
5. Are you or are you representing the current owner(s) of record of this permit?
Yes
No (If "Yes", proceed to question 6)
a. If you are not the current owner(s) of record, has a Report of Convenance been filed with NDWR?
Yes
No
If "Yes", when was the Report of Conveyance filed with NDWR?
6. Does this permit have multiple owners?
Yes
No (If "No", proceed to question 7)
a. If the permit has multiple owners, on whose behalf is this application being filed?
All
Portion:
Name(s) of owners for which this application is filed
7. The permittee requests an extension of time for year(s) within which to comply with the provisions for filing the Proof of Completion of Work.
8. If requesting more than one year for extension of time, please state the reason for requesting multiple years.
9. How much additional time is needed to complete the works of diversion?
10. What is the expenditure on the project under this permit? (a) Last year $ (b) Total to date $
11. If the source of water is underground, has the well been drilled and equipped?
Yes
No
N/A
a. If the well has been drilled, please list the well log number:
b. If the well has not been drilled, has a Nevada licensed well driller been contacted?
Yes
No
12. If the source is surface water, have the diversion works been installed?
Yes
No
N/A
If "Yes", please describe the diversion works.
13. Has a totalizing meter or suitable measuring device been properly installed?
Yes
No
If "Yes", please describe the totalizing meter or measuring device.
14. If a monitoring plan is required under the terms of the permit, has it been submitted to NDWR?
Yes
No
N/A
If "No", why?
15. Describe what work must be completed before water can be diverted under the terms of the permit.
16. Describe the progress made during the previous year(s) and explain why this request for an extension of time is needed.
17. Describe your plans for the next year(s) towards completing your Proof of Completion of Work.
By checking       pursuant to NRS 53.045, I hereby certify, under penalty of perjury, that the foregoing is true and correct.
Mailing Address
Street or PO Box
City
State
ZIP Code
Phone
Email

Confirm Email
YOU WILL BE PROMPTED FOR A $120 FILING FEE PER YEAR REQUESTED IN THIS APPLICATION FOR EXTENSION OF TIME.
A SEPARATE APPLICATION MUST BE FILED FOR EACH PERMIT.