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BEFORE THE STATE ENGINEER OF THE STATE OF NEVADA
APPLICATION FOR EXTENSION OF TIME FOR FILING PROOF OF BENEFICIAL USE AND CULTURAL MAP
MANNER OF USE: IRRIGATION
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 and extension of time for year(s) within which to comply with the provisions for filing the Proof of Beneficial Use
and supporting Cultural Map.
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 place the permitted water to beneficial use?
10. What is the expenditure on the project under this permit? (a) Last year $ (b) Total to date $
11. Are there any other water rights associated with this place of use and/or point of diversion?
Yes
No
12. Totalizing Meter Reading:
acre-feet
gallons
List the date on which the totalizing meter was read:
a. If not metered, please describe the method for measuring the diversion of water.
13. Amount of water beneficially used in the last 12 months:
acre-feet
gallons
14. Is this permit supplemental to a surface water source?
Yes
No
a. If "Yes", what is the permit(s) and/or claim number(s) to which this permit is supplemental and what percentage of the total delivery was
received from the surface water source?
15. Number of acres allowed within the permitted place of use:
16. Number of acres in production within the permitted place of use:
17. Culture type(s) produced:
18. Irrigation method (eg. flood, drip, pivot sprinkler, wheel line sprinkler, etc.):
19. Describe what work must be completed before water can be placed to beneficial use under the terms of the permit.
20. Describe the progress made during the previous year(s) and explain why this request for an extension of time is needed.
21. Describe your plans for the next year(s) towards completing the Proof of Beneficial Use and supporting Cultural Map.
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.