OAR 690-053-0010
Amendment Application Form
(1)
Applicant’s name, mailing address, and telephone number.(2)
Name appearing on permit, certificate or license, if different.(3)
Type of change proposed.(4)
Number of the permit, certificate or license.(5)
Source of water.(6)
Date of priority.(7)
The existing points of diversion and points of use located accurately on a map in reference to a public land survey corner.(8)
A general description of the current facilities, including capacity.(9)
A statement explaining the reason for the proposed amendment consistent with 690-053-0020 (Amendment Criteria) through 0030.(10)
Evidence that the water has been used within the past five years in accordance with the terms and conditions of the permit, certificate or license. The evidence may include:(a)
Affidavits from knowledgeable persons, such as the owner or operator, a neighbor, power purchaser.(b)
Receipts or expenditures related to the use of water.(c)
Other records such as dated photographs.(11)
If for a redistribution or augmentation of water use a letter from the affected wildlife and/or environmental quality agency endorsing the change.(12)
A listing of all affected local governments, including county, city, municipal corporations, and tribal governments.(13)
An oath that the information contained in the application is true and accurate.(14)
The signature of the applicant, and if an entity, the title of the authorized representative signing the form.(15)
The appropriate fee as required under ORS 536.050 (Fees)(h).
Source:
Rule 690-053-0010 — Amendment Application Form, https://secure.sos.state.or.us/oard/view.action?ruleNumber=690-053-0010.