Wyoming Administrative Code › Agency 037 - Engineer, State › Sub-Agency 0007 - Board of Control - Water Administration › Appendix A - SAMPLE PETITIONS AND FORMS

Current through July 13, 2024
PETITION FOR CHANGE OF POINT ) OF DIVERSION OF THE FOLLOWING )
				APPROPRIATIONS: )
A. THE JONATHAN J. DOE ) APPROPRIATION, TERRITORIAL )
				APPROPRIATION, DIVERTING FROM ) NO NAME CREEK, TRIBUTARY NO ) BEFORE THE NAME
				RIVER, THROUGH THE NO ) STATE BOARD OF CONTROL NAME DITCH, WITH PRIORITY OF )
				CHEYENNE, WYOMING MAY 16, 18 85; )
B. THE JANE ALEXANDRA DOE ) APPROPRIATION, PERMIT NO. 3214 )
				ENL., DIVERTING FROM NO NAME ) CREEK, TRIBUTARY NO NAME ) RIVER, THROUGH THE
				ENLARGED NO ) NAME DITCH, WITH PRIORITY OF ) OCTOBER 9, 1922. )
O.R. 2, P. 446; C.R. 2, P. 435; PROOF NO. 1491
O.R. 7, P. 123; C.R. 32, P. 436; PROOF NO. 11411
STATE OF WYOMING )
) SS
COUNTY OF FREMONT )
COMES NOW John Doe of Box 00, Lander, County of Fremont, State
				of Wyoming, who being duly sworn on oath according to law does hereby make the
				following statement of facts and petition:
1. THAT he is the owner of the lands and the appropriations
				  involved as evidenced by the attached proof of ownership from the County Clerk
				  of Fremont County, Wyoming.
2. THAT the appropriations involved are as follows:
a. The Jonathan J. Doe Appropriation, Territorial
					 Appropriation, adjudicated under Proof No. 1491, in the amount of 0.57 c.f.s.
					 for the irrigation of 40.0 acres, diverting from No Name Creek, tributary No
					 Name River, through the No Name Ditch, with priority of May 16, 1885, and of
					 record in Order Record 2, page 446; Certificate Record 2, page 435 describing
					 the lands irrigated as follows:
Township 30 North, Range
100 West
Section 17: NW1/4SW1/4
2 5.0 acres
SW1/4SW1/4
15.0
Total
40.0 acres (0.57 c.f.s.)
b. The Jane Alexandra Doe Appropriation, Permit No. 3214
						Enl., adjudicated under Proof No. 11411, in the amount of 1.71 c.f.s. for the
						irrigation of 120.0 acres, diverting from No Name Creek, tributary No Name
						River, through the No Name Ditch, with priority of October 9, 1922, and of
						record in Order Record 7, page 123; Certificate Record 32, page 436 describing
						the lands irrigated as follows:
Township 30 North, Range 100
								  West
Section 16: SW1/4NW1/4
10.0 acres
NW1/4SW1/4
10.0
Section 17: SE1/4NE1/4
2 0.0
NE1/4SE1/4
4 0.0
SE1/4SE1/4
40.0
Total
120.0 acres (1.71 c.f.s.)
3. THAT your petitioner desires to change the point of
						  diversion of the No Name Ditch, Territorial Appropriation, and Permit No. 3214
						  Enl., from its point of diversion of record on No Name Creek, described as
						  North 10° 15' West, 320.0 feet distant from the Southeast Corner of Section
						  13, Township 30 North, Range 100 West, and situated in the SE1/4SE1/4 of
						  Section 13, to a new point of diversion diverting from the same source of
						  supply approximately 500 feet downstream at a point described as North 20°
						  10' East, 600.0 feet distant from the Southwest Corner of Section 18, Township
						  30 North, Range 99 West, and situated in the SWSW1
						  of Section 18.
The lands for which this change is requested are
						  described as follows:
A. The Jonathan J. Doe Appropriation, Territorial
							 Appropriation, Proof No. 1491:
Township 30 North,
										Range
100 West
Section 17: NW1/4SW1/4
2 5.0 acres
SW1/4SW1/4
15.0
Total
40.0 acres (0.57 c.f.s.)
B. The Jane Alexandra Doe Appropriation, Permit No.
								3214 Enl., Proof No. 11411:
Township 30 North, Range 100
										  West
Section 16: SW1/4NW1/4
10.0 acres
NW1/4SW1/4
10.0
Section 17: SE1/4NE1/4
2 0.0
NE1/4SE1/4
4 0.0
SE1/4SE1/4
40.0
Total
120.0 acres (1.71 c.f.s.)
Total acreage to be changed to the new point of
								diversion is 160.0 acres (2.28 c.f.s.).
4. THAT this proposed change of point of
								  diversion is necessary because flooding through No Name Creek has washed a deep
								  channel at the site of the present headgate. The new proposed point of
								  diversion will provide a more practical point to install a permanent
								  headgate.
5. THAT there are no record intervening points
									 of diversion (headgates) between the point of diversion of record of the No
									 Name Ditch and the proposed new point of diversion of the No Name Ditch.
6. THAT there are no intervening tributaries
										or other sources of supply which might affect the rights of other
										appropriators.
7. THAT a properly prepared map showing the
										  actual situation on the ground accompanies this petition.
8. THAT the granting of this petition
											 will not injure any other appropriators. It is the prayer of your petitioner
											 that this petition for change of point of diversion, as outlined in paragraph 3
											 above, be allowed without loss of priority, and that a proper Order of the
											 Board be entered recording same.
Respectfully submitted,
____________________
John Doe
The foregoing instrument was acknowledged
											 before me this ___ day of __________________, 20______.
Witness my hand and official seal.
______________________
Notarial Officer
My Commission expires:
											 _____________________________________
PETITION FOR CHANGE OF POINT )
OF DIVERSION AND MEANS OF )
CONVEYANCE OF THE J. W. DOE )
APPROPRIATION, PERMIT NO. ) BEFORE
											 THE
3214, DIVERTING FROM NO NAME ) STATE
											 BOARD OF CONTROL
CREEK, TRIBUTARY NO NAME ) CHEYENNE,
											 WYOMING
RIVER, THROUGH THE NO NAME )
DITCH, WITH PRIORITY OF MAY )
16, 19 05, TO BE CHANGED TO THE )
UNNAMED DITCH. )
O.R. 2, P. 446; C.R. 3, P. 435; PROOF NO.
											 3491
STATE OF WYOMING )
) SS
COUNTY OF FREMONT )
COMES NOW John Doe of Box 00, Split Rock,
											 County of Fremont, State of Wyoming, who being duly sworn on oath according to
											 law does hereby make the following statement of facts and petition:
1. THAT he is the owner of the lands
												and the appropriation for which a change of point of diversion and means of
												conveyance is sought, as evidenced by the attached proof of ownership from the
												County Clerk of Fremont County, Wyoming.
2. THAT the appropriation for which a
												  change of point of diversion and means of conveyance is sought is the J. W. Doe
												  Appropriation, Permit No. 3214, adjudicated under Proof No. 3491, in the amount
												  of 0.89 c.f.s. for the irrigation of 62.0 acres, diverting from No Name Creek,
												  tributary No Name River, through the No Name Ditch, with priority of May 16,
												  1905, and of record in Order Record 2, page 446; Certificate Record 3, page 435
												  describing the lands irrigated as follows:
Township 30
															 North, Range
98 West
Section 19:
															 SW1/4SW1/4
32.0 acres
SE1/4SW1/4
10.0
Section 30:
															 NW1/4NW1/4
20.0
Total
62.0 acres (0.89
															 c.f.s.)
3. THAT your petitioner requests a
													 change of point of diversion and means of conveyance of the J. W. Doe
													 Appropriation, Permit No. 3214, which diverts from No Name Creek through the No
													 Name Ditch, at a point described as North 12° 30' East, 1620.0 feet distant
													 from the Southwest Corner of Section 28, Township 30 North, Range 99 West, and
													 situated in the SESW1 of Section 28, to the Unnamed
													 Ditch, diverting from the same source of supply, under Permit No. 3400,
													 approximately H mile downstream at a point described as North 15° 20' East,
													 1056.0 feet distant from the Southwest Corner of Section 28, Township 30 North,
													 Range 99 West, and situated in the SW1/4SW1/4 of Section 28.
The lands for which this change is
													 requested are described as follows:
Township 30
																North, Range
98 West
Section 19:
																SW1/4SW1/4
32.0 acres
SE1/4SW1/4
10.0
Section 30:
																NW1/4NW1/4
20.0
Total
62.0 acres (0.89
																c.f.s.)
4. THAT the reason for the
														requested change is that a portion of the No Name Ditch is subject to washouts
														and has been difficult to maintain. A change of point of diversion and means of
														conveyance to the Unnamed Ditch will eliminate this problem and provide a more
														economical means of conveyance.
5. THAT consent from Robert
														  Smith, sole owner of the Unnamed Ditch, Permit No. 3400, accompanies this
														  petition.
6. THAT there are no record
															 intervening points of diversion (headgates) between the point of diversion of
															 the No Name Ditch and the point of diversion of the Unnamed Ditch.
7. THAT there are no
																intervening tributaries or other sources of supply which might affect the
																rights of other appropriators.
8. THAT a properly
																  prepared map showing the actual situation on the ground accompanies this
																  petition.
9. THAT the granting of
																	 this petition will not injure any other appropriators. It is the prayer of your
																	 petitioner that this petition for change of point of diversion and means of
																	 conveyance, as outlined in paragraph 3 above, be allowed without loss of
																	 priority, and that a proper Order of the Board be entered recording same.
Respectfully
																	 submitted,
________________
John Doe
The foregoing
																	 instrument was acknowledged before me this ___ day of __________________,
																	 20______.
Witness my hand and
																	 official seal.
___________________
Notarial Officer
My Commission expires:
																	 _____________________________________
PETITION FOR AN AMENDED
																	 )
CERTIFICATE OF
																	 APPROPRIATION )
FOR THE JONATHAN W. DOE
																	 )
APPROPRIATION,
																	 TERRITORIAL ) BEFORE THE
APPROPRIATION,
																	 DIVERTING FROM ) STATE BOARD OF CONTROL
NO NAME CREEK,
																	 TRIBUTARY NO ) CHEYENNE, WYOMING
NAME RIVER, THROUGH THE
																	 NO )
NAME DITCH, WITH
																	 PRIORITY OF )
APRIL 21, 188 6.
																	 )
O.R. 2, P. 446; C.R. 2,
																	 P. 435; PROOF NO. 1491
STATE OF WYOMING
																	 )
) SS
COUNTY OF SUBLETTE
																	 )
COMES NOW John Doe of
																	 Box 00, Big Piney, County of Sublette, State of Wyoming, who being duly sworn
																	 on oath according to law does hereby make the following statement of facts and
																	 petition:
1. THAT he is the
																		owner of the lands and the appropriation for which an amended certificate of
																		appropriation is sought, as evidenced by the attached proof of ownership from
																		the County Clerk of Sublette County, Wyoming.
2. THAT the
																		  appropriation for which an amended certificate is sought is the Jonathan W. Doe
																		  Appropriation, Territorial Appropriation, adjudicated under Proof No. 1491, in
																		  the amount of 2.71 c.f.s. for the irrigation of 190.0 acres, diverting from No
																		  Name Creek, tributary No Name River, through the No Name Ditch, with priority
																		  of April 21, 1886, and of record in Order Record 2, page 446; Certificate
																		  Record 2, page 435 describing the lands irrigated as follows:
Township
																					 29
North, Range 111 West
Section 14:
																					 SE1/4
Section 23:
																					 N1/4NE1/4
_____
Total
190.0
																					 acres (blanket description)
3. THAT your
																			 petitioner requests that an amended certificate of appropriation for the
																			 Jonathan W. Doe Appropriation, Territorial Appropriation, Proof No. 1491, be
																			 issued as follows:
Township
																						29 North, Range 111 West
Section
																						14: NE1/4SE1/4
10.0
																						acres
NW1/4SE1/4
2
																						0.0
SW1/4SE1/4
4
																						0.0
SE1/4SE1/4
4
																						0.0
Section
																						23: NE1/4NE1/4
4
																						0.0
NW1/4NE1/4
25.0
Total
175.0
																						acres (2.50 c.f.s.)
This amendment
																			 results in the reduction of 15.0 acres (0.21 c.f.s.) under this
																			 appropriation.
4. THAT the
																				reason for this amendment is to describe those lands which have been
																				historically irrigated and are currently being irrigated and to correct the
																				records to agree with the actual situation on the ground.
5. THAT
																				  recording fees in the amount of __________________ accompany the
																				  petition.
6. THAT a
																					 properly prepared map showing the actual situation on the ground accompanies
																					 this petition.
7. THAT
																						the granting of this petition will not injure any other appropriators.
It is the
																						prayer of your petitioner that a proper Order of the State Board of Control be
																						entered to describe the lands under the Jonathan W. Doe Appropriation, as
																						outlined in paragraph 3 above, and that an amended certificate of appropriation
																						be issued for the same.
Respectfully
																						submitted,
____________________
John
																						Doe
The
																						foregoing instrument was acknowledged before me this ___ day of
																						__________________, 20______.
Witness
																						my hand and official seal.
___________________
Notarial
																						Officer
My
																						Commission expires: _____________________________________
PETITION
																						FOR CHANGE OF USE )
FROM
																						IRRIGATION TO MUNICIPAL )
USE AND
																						CHANGE OF POINT OF )
DIVERSION
																						AND MEANS OF )
CONVEYANCE
																						OF THE J. W. DOE ) BEFORE THE
APPROPRIATION,
																						TERRITORIAL ) STATE BOARD OF CONTROL
APPROPRIATION,
																						DIVERTING FROM ) CHEYENNE, WYOMING
NO NAME
																						RIVER THROUGH THE NO )
NAME
																						DITCH, WITH PRIORITY OF )
MAY 16,
																						18 85, TO BE CHANGED TO )
THE NO
																						NAME MUNICIPAL )PIPELINE.)
O.R. 2,
																						P. 446; C.R. 2, P. 30; PROOF NO. 919
STATE OF
																						WYOMING )
) SS
																						COUNTY OF NATRONA )
COMES NOW
																						the Town of Rodgers, acting through its Mayor, James J. Jones, of P.O. Box 40,
																						Rodgers, County of Natrona, State of Wyoming, who being duly sworn on oath
																						according to law, does hereby make the following statements of fact and
																						petition:
1. THAT
																						  the Town of Rodgers is the owner of the appropriation for which a change of use
																						  and change of point of diversion and means of conveyance is sought as evidenced
																						  by an Authorization to Detach Water Right which accompanies this
																						  petition.
2.
																							 THAT the appropriation for which a change of use from irrigation to municipal
																							 use and change of point of diversion and means of conveyance is sought is the
																							 J. W. Doe Appropriation, Territorial Appropriation, adjudicated under Proof No.
																							 919, in the amount of 1.0 c.f.s. for the irrigation of 70.0 acres, diverting
																							 from No Name River through the No Name Ditch, with priority of May 16, 1885,
																							 and of record in Order Record 2, page 446; Certificate Record 2, page 30
																							 describing the lands irrigated as follows:
Township
																										38 North, Range
79 West
Section
																										13: NE1/4NW1/4
35.0 acres
NW1/4NW1/4
35.0
Total
70.0 acres (1.0 c.f.s.)
3.
																								THAT water under this appropriation has been applied to beneficial use upon the
																								lands in accordance with statutory provisions, and your petitioner desires to
																								change the use of same from irrigation to a preferred use for municipal
																								purposes to be used within the city limits of the Town of Rodgers described as
																								follows:
Township
																										  39 North, Range 78 West
Section 6: EH
Section 5: WHWH
4.
																								  THAT your petitioner also requests a change of point of diversion and means of
																								  conveyance of the J. W. Doe Appropriation, as changed from irrigation to
																								  municipal purposes, from its record point of diversion on the No Name River
																								  described as South 25° 10' East, 273.0 feet distant from the Northwest
																								  Corner of Section 13, Township 38 North, Range 79 West, and situated in the
																								  NW1/4NW1/4 of Section 13, to the No Name Municipal Pipeline, a new facility,
																								  which diverts from the same source of supply approximately 4 miles downstream
																								  at a point described as South 27° 5' East, 9 6 9.0 feet distant from the
																								  West Quarter Corner of Section 6, Township 39 North, Range 78 West, and
																								  situated in the NW1/4SW1/4 of Section 6.
5.
																									 THAT there are two (2) record intervening points of diversion between the point
																									 of diversion of the No Name Ditch and the point of diversion of the No Name
																									 Municipal Pipeline. These intervening points of diversion are for the following
																									 facilities:
No
																									 Flow Ditch, Permit No. 235
Full
																									 Flow Ditch, Permit Nos. 45 6 and 12 3 Enl.
6.
																										THAT consents from the owners of these intervening facilities accompanies the
																										petition.
7.
																										  THAT a consumptive use study prepared by John W. Stag, a registered
																										  professional engineer, accompanies the petition. This study indicates the
																										  consumptive use is 48%. Therefore, your petitioner requests that 0.48 c.f.s. of
																										  the J. W. Doe Appropriation be changed from irrigation to municipal purposes
																										  and that the remaining 0.52 c.f.s. will not be diverted and will remain in the
																										  system to satisfy return flows.
8.
																											 THAT a properly prepared map showing the location of lands from which the
																											 appropriation is to be detached, the new points of use, and the location of the
																											 No Name Municipal Pipeline accompanies the petition.
9.
																												THAT recording fees in the amount of __________________ accompany the
																												petition.
10.
																												  THAT the granting of this petition will not injure any other appropriators. It
																												  is the prayer of the petitioner:
A.
																												  THAT the appropriation of water herein described, which has been acquired by
																												  the Town of Rodgers, be changed from irrigation to municipal purposes for use
																												  within the city limits of the Town of Rodgers;
B.
																													 THAT the point of diversion and means of conveyance for the J. W. Doe
																													 Appropriation as changed to municipal purposes be allowed in accordance with
																													 paragraph 4 above;
C.
																														THAT a hearing be held as provided by
																														W.S.
																														41-3-103 and W.S. W.S.
																														W.S.
																														41-3-104;
D.
																														  THAT a proper Order of the State Board of Control be entered recording same and
																														  that an amended certificate be issued to the Town of Rodgers.
Respectfully
																														  submitted,
____________________
James
																														  J. Jones, Mayor
Town of Rodgers
The
																														  foregoing instrument was acknowledged before me this day of __________________,
																														  20________.
Witness
																														  my hand and official seal.
_____________________
Notarial
																														  Officer
My Commission expires: ___________________________________________
PETITION
																														  FOR CHANGE OF PLACE )
OF
																														  USE OF A PORTION OF THE J. )
W.
																														  DOE APPROPRIATION, PERMIT ) BEFORE THE
NO.
																														  7 609, DIVERTING FROM NO ) STATE BOARD OF CONTROL
NAME
																														  CREEK, TRIBUTARY NO NAME ) CHEYENNE, WYOMING
RIVER,
																														  THROUGH THE NO NAME )
CANAL,
																														  WITH PRIORITY OF APRIL )
9,
																														  1902. )
O.R.
																														  17, P. 352; C.R. 68, P. 310; PROOF NO. 282501/2
STATE
																														  OF WYOMING )
)
																														  SS
COUNTY OF WASHAKIE )
COMES
																														  NOW John Doe of 0000 Road 00, Worland, County of Washakie, State of Wyoming,
																														  and the J. W. Doe Irrigation District, acting through its Chairman, Buck Doe,
																														  of Route 0, Box 000, Worland, County of Washakie, State of Wyoming, whom being
																														  duly sworn on oath according to law do hereby make the following statements of
																														  facts and petition:
1.
																															 THAT John Doe is the present owner of the portion of the appropriation to be
																															 affected by this petition, and is included within the boundaries of the J. W.
																															 Doe Irrigation District, as evidenced by the copy of Warranty Deed from the
																															 County Clerk of Washakie County, Wyoming.
2.
																																THAT the appropriation for which a change of place of use is sought is the J.
																																W. Doe Appropriation, Permit No. 7609, adjudicated under Proof No. 28250, in
																																the amount of 1.79 c.f.s. for the irrigation of 125.0 acres, diverting from No
																																Name Creek, tributary No Name River, through the No Name Canal, with priority
																																of April 9, 1902, and of record in Order Record 17, page 352; Certificate
																																Record 68, page 310 describing the lands irrigated as follows:
Township
																																		  46 North, Range 92 West, Resurvey
Tract
																																		  38A:
14.0 acres
Tract
																																		  38E:
22.0
Tract
																																		  38F:
42.0
Tract
																																		  38G:
4.0
Tract
																																		  38H:
43.0
Total
125.0 acres (1.79 c.f.s.)
3.
																																  THAT your petitioners desire to redescribe this appropriation so as to set out
																																  the lands to be irrigated as follows:
The
																																  J. W. Doe Appropriation, Permit No. 7609, Proof No. 282501/2:
Township
																																			 46
North, Range 92 West,
																																			 Resurvey
Tract
																																			 38A:
12.3 acres
Tract
																																			 38E:
25.1
Tract
																																			 38F:
39.0
Tract
																																			 38G:
26.9
Section
																																			 5: Lot 11
0.6
Section
																																			 6: Lot 11
21.1
Total
125.0 acres (1.79 c.f.s.)
4.
																																	 THAT the reason for the change of place of use is due to the slope and type of
																																	 soil in the area, which causes erosion problems when flood irrigated. The
																																	 petitioners are replacing the flood irrigation system with a center pivot
																																	 sprinkler system to alleviate the erosion problem and to reduce labor
																																	 costs.
5.
																																		THAT recording fees in the amount of __________________ accompany the
																																		petition.
6.
																																		  THAT a properly prepared map showing the actual situation on the ground
																																		  accompanies this petition.
7.
																																			 THAT the granting of this petition will not injure any other appropriators.
It is the prayer of your petitioners that a proper Order of the State Board of
																																			 Control be entered to describe the lands to be irrigated under a portion of the
																																			 J. W. Doe Appropriation, as shown in paragraph 3 above, and that an amended
																																			 certificate be issued for the same.
Respectfully submitted,
__________________
John
																																			 Doe
The
																																			 foregoing instrument was acknowledged before me this ___ day of
																																			 __________________, 20______.
Witness
																																			 my hand and official seal.
_______________
Notarial
																																			 Officer
My
																																			 Commission expires: _____________________________________
Respectfully
																																			 submitted,
________________
Buck
																																			 Doe, Chairman
J.
																																			 W. Irrigation District
The
																																			 foregoing instrument was acknowledged before me this ___
day
																																			 of __________________, 20______.
Witness
																																			 my hand and official seal.
_____________________
Notarial
																																			 Officer
My Commission expires: _____________________________________
PETITION
																																			 FOR DECLARATION OF )
ABANDONMENT
																																			 OF THE J. W. DOE )
APPROPRIATION,
																																			 TERRITORIAL ) BEFORE THE
APPROPRIATION,
																																			 DIVERTING FROM ) STATE BOARD OF CONTROL
NO
																																			 NAME CREEK, TRIBUTARY NO ) CHEYENNE, WYOMING
NAME
																																			 RIVER, THROUGH THE NO )
NAME
																																			 DITCH, WITH PRIORITY OF )
MAY
																																			 16, 18 85. )
O.R.
																																			 2, P. 446; C.R. 2, P. 435; PROOF NO. 1281
STATE
																																			 OF WYOMING )
)
																																			 SS
COUNTY OF JOHNSON )
COMES
																																			 NOW John Doe of Box 000, Buffalo, County of Johnson, State of Wyoming, who
																																			 being duly sworn on oath according to law does hereby make the following
																																			 statement of facts and petition:
1.
																																				THAT your petitioner is the owner of the lands and the following described
																																				appropriation of water attached thereto as evidenced by the accompanying proof
																																				of ownership from the County Clerk of Johnson County, Wyoming.
The
																																				Jane Doe Appropriation, Permit No. 2200, adjudicated under Proof No. 3810, in
																																				the amount of 1.53 c.f.s. for the irrigation of 107.0 acres, diverting from No
																																				Name Creek, tributary No Name River, through the Unnamed Ditch, with priority
																																				of January 15, 1903, and of record in Order Record 3, page 410; Certificate
																																				Record 6, page 370 describing the lands irrigated as follows:
Township
																																						  46 North, Range
80
																																						  West
Section
																																						  12: SE1/4SW1/4
30.0 acres
SW1/4SE1/4
37.0
SE1/4SE1/4
40.0
Total
107.0 acres (1.53 c.f.s.)
2.
																																				  THAT James Doe of Box 0, Buffalo, County of Johnson, State of Wyoming, is the
																																				  owner of record of the lands to which the following described appropriation is
																																				  attached as evidenced by the accompanying proof of ownership from the County
																																				  Clerk of Johnson County, Wyoming:
The
																																				  J. W. Doe Appropriation, Territorial Appropriation, adjudicated under Proof No.
																																				  1281, in the amount of 1.47 c.f.s. for the irrigation of 103.0 acres, diverting
																																				  from No Name Creek, tributary No Name River, through the No Name Ditch, with
																																				  priority of May 16, 1885, and of record in Order Record 2, page 446;
																																				  Certificate Record 2, page 435 describing the lands irrigated as
																																				  follows:
Township
																																							 46 North, Range
80
																																							 West
Section 10: NE1/4SE1/4
2
																																							 0.0 acres
SE1/4SE1/4
10.0
Section 11: NW1/4SW1/4
35.0
SW1/4SW1/4
38.0
Total
103.0 acres (1.47 c.f.s.)
Total
																																				  acreage for which a declaration of abandonment is sought by this petition is
																																				  103.0 acres (1.47 c.f.s.).
3.
																																					 THAT your petitioner has standing to file this petition because (fully describe
																																					 elements of standing here).
4.
																																						THAT water under the J. W. Doe Appropriation, Territorial Appropriation, the No
																																						Name Ditch, has not been diverted and applied to beneficial use upon the lands
																																						described in paragraph 2 above for at least five (5) successive years past,
																																						when water was available for this purpose.
5.
																																						  THAT your petitioner will be benefited by a declaration of abandonment of this
																																						  appropriation, or injured by the reactivation of this water right, as follows:
																																						  (fully describe elements of benefit or injury here).
6.
																																							 THAT recording fees in the amount of __________________ accompany the petition.
It
																																							 is the prayer of your petitioner that a hearing be held as provided by W.S.
																																							 W.S. W.S.
																																							 41-3-401, and that after the provisions of
																																							 the statutes have been complied with a proper Order of the State Board of
																																							 Control be entered declaring an abandonment of the appropriation described in
																																							 paragraph 2 above.
Respectfully
																																							 submitted,
________________
John
																																							 Doe
The
																																							 foregoing instrument was acknowledged before me this ___ day of
																																							 __________________, 20______.
Witness
																																							 my hand and official seal.
_______________
Notarial
																																							 Officer
My Commission expires: _____________________________________
PETITION
																																							 FOR VOLUNTARY )
ABANDONMENT
																																							 OF THE J. W. DOE )
APPROPRIATION,
																																							 TERRITORIAL ) BEFORE THE
APPROPRIATION,
																																							 DIVERTING FROM ) STATE BOARD OF CONTROL
NO
																																							 NAME CREEK, TRIBUTARY NO ) CHEYENNE, WYOMING
NAME
																																							 RIVER, THROUGH THE NO )
NAME
																																							 DITCH, WITH PRIORITY OF )
JANUARY
																																							 1, 1889. )
O.R.
																																							 2, P. 446; C.R. 2, P. 22; PROOF NO. 1491
STATE
																																							 OF WYOMING )
)
																																							 SS
COUNTY OF CARBON )
COMES
																																							 NOW John Doe of Rural Route 0, Canyon, County of Carbon, State of Wyoming, who
																																							 being duly sworn on oath according to law does hereby make the following
																																							 statement of facts and petition:
1.
																																								THAT he is the owner of the appropriation for which voluntary abandonment is
																																								sought as evidenced by the attached proof of ownership from the County Clerk of
																																								Carbon County, Wyoming.
2.
																																								  THAT the appropriation for which voluntary abandonment is sought is the J. W.
																																								  Doe Appropriation, Territorial Appropriation, adjudicated under Proof No. 1491,
																																								  in the amount of 1.14 c.f.s. for the irrigation of 80.0 acres, diverting from
																																								  No Name Creek, tributary No Name River, through the No Name Ditch, with
																																								  priority of January 1, 1889, and of record in Order Record 2, page 446;
																																								  Certificate Record 2, page 22; describing the lands irrigated as follows:
Township
																																											 12 North,
Range 80 West
Section
																																											 2: NE1/4NE1/4
30.0 acres
NW1/4NE1/4
2 0.0
SW1/4NE1/4
30.0
Total
80.0 acres (1.14 c.f.s.)
3.
																																									 THAT the No Name Ditch does not exist on the ground and has not existed for
																																									 many years. Water is not currently being diverted and beneficially used and
																																									 will not be diverted and beneficially used in the future.
4.
																																										THAT your petitioner declares his intention to voluntarily abandon the
																																										appropriation described in paragraph 2 above and requests that a proper Order
																																										of the Board be entered declaring such abandonment.
5.
																																										  THAT no fees are required for this petition.
Respectfully
																																										  submitted,
__________________
John
																																										  Doe
The
																																										  foregoing instrument was acknowledged before me this ___ day of
																																										  __________________, 20______.
Witness
																																										  my hand and official seal.
_____________________
Notarial
																																										  Officer
My Commission expires: _____________________________________
APPEAL
																																										  FROM THE ENDORSEMENT OF )
THE
																																										  STATE ENGINEER UPON THE ) BEFORE THE
APPLICATION
																																										  FOR PERMIT TO ) STATE BOARD OF CONTROL
CONSTRUCT
																																										  THE NO NAME DITCH, ) CHEYENNE, WYOMING
TEMPORARY
																																										  FILING NO. 00 5/150. )
STATE
																																										  OF WYOMING )
)
																																										  SS
COUNTY OF CONVERSE )
COMES
																																										  NOW John Doe of Bill, County of Converse, State of Wyoming, who being duly
																																										  sworn on oath according to law does hereby make the following statement of
																																										  facts and appeal:
1.
																																											 THAT your appellant filed in the Office of the State Engineer on June 1, 1982,
																																											 an application, which application was given Temporary Filing No. 00 5/150, to
																																											 construct the No Name Ditch, and that on July 10, 1982, the State Engineer
																																											 returned said application with the following endorsement thereon:
"This
																																											 is to certify that I have examined the foregoing application and have rejected
																																											 same for the reason that it conflicts with existing rights and threatens to
																																											 become detrimental to the public interest."
2.
																																												THAT your appellant feels himself aggrieved by the said endorsement of the
																																												State Engineer as follows:
a.
																																												THAT the conflict stated therein may be removed by excluding certain tracts
																																												from the application;
b.
																																												  THAT the allowance of this application is not detrimental to the public
																																												  interest.
Your
																																												  appellant, therefore, requests the State Board of Control to hold a hearing as
																																												  provided by W.S. W.S.
																																												  W.S.
																																												  41-4-517, and that a proper Order be entered
																																												  upon the records of the State Board of Control reversing the action of the
																																												  State Engineer.
Respectfully
																																												  submitted,
_______________
John
																																												  Doe
The
																																												  foregoing instrument was acknowledged before me this ___ day of
																																												  __________________, 20______.
Witness
																																												  my hand and official seal.
____________________
Notarial
																																												  Officer
My Commission expires: _____________________________________
PETITION
																																												  FOR CHANGE OF )
LOCATION
																																												  OF THE NO NAME WELL, ) BEFORE THE
PERMIT
																																												  NO. U.W. 3214, WITH ) STATE BOARD OF CONTROL
PRIORITY
																																												  OF APRIL 3, 1959. ) CHEYENNE, WYOMING
O.R.
																																												  16, P. 261; C.R.U.W. 1, P. 38; PROOF NO. U.W. 121
STATE
																																												  OF WYOMING )
)
																																												  SS
COUNTY OF ALBANY )
COMES
																																												  NOW John Doe of Rex Route, Box 20, Laramie, County of Albany, State of Wyoming,
																																												  who being duly sworn on oath according to law, does hereby make the following
																																												  statement of facts and petition:
1.
																																													 THAT he is the owner of the lands irrigated under the well and the
																																													 appropriation of water to be changed as evidenced by the attached proof of
																																													 ownership from the County Clerk of Albany County, Wyoming.
2.
																																														THAT the well to be relocated is the No Name Well, Permit No. U.W. 3214, the J.
																																														W. Doe Appropriation, adjudicated under Proof No. U.W. 121, in the amount of
																																														500.0 gallons per minute for the irrigation of 105.0 acres, with priority of
																																														April 3, 1959, and of record in Order Record 18, page 291; Certificate Record
																																														U.W. 1, page 38 describing the lands irrigated as follows:
Township
																																																  13 North, Range
75
																																																  West
Section 14: SW1/4SE1/4
10.0 acres
SE1/4SE1/4
2 5.0
Section 23: NE1/4NE1/4
4 0.0
NW1/4NE1/4
30.0
Total
105.0
																																																  acres
3.
																																														  THAT your petitioner desires to change the location of the No Name Well, Permit
																																														  No. U.W. 3214, from its present location described as South 15° 45' West,
																																														  125.0 feet distant from the Northeast Corner of Section 23, Township 13 North,
																																														  Range 75 West, and situated in the NE1/4NE1/4 of Section 23, to a new location
																																														  described as North 45° 15' West, 48.0 feet distant from the Southeast
																																														  Corner of Section 14, Township 13 North, Range 75 West, and situated in the
																																														  SE1/4SE1/4 of Section 14.
4.
																																															 THAT the lands now irrigated (105.0 acres) and the amount of the appropriation
																																															 (500.0 g.p.m.) will not be affected by the granting of this petition.
5.
																																																THAT the reason for the requested change is that the casing of the present well
																																																has deteriorated and a partial cave in has occurred, which drastically reduced
																																																the amount of water available. It was determined that it was more economical to
																																																relocate the No Name Well than to repair the No Name Well.
6.
																																																  THAT the proposed new location is within the same ground water basin (aquifer)
																																																  and as nearly as can be determined, will pump water from the same
																																																  aquifer.
7.
																																																	 THAT no map is required with this petition but a Letter Certificate of Survey
																																																	 from a licensed Wyoming surveyor describing the new location by tie by distance
																																																	 and direction accompanies this petition.
8.
																																																		THAT no fees are required for this petition.
9.
																																																		  THAT power records for at least the last five (5) years past which indicates
																																																		  that the well has been beneficially used accompanies the petition.
10.
																																																			 THAT the original No Name Well will be abandoned and sealed in accordance with
																																																			 the State Engineer's Rules and Regulations for wells. A Statement of Completion
																																																			 (Form U.W. 6) will be submitted within 30 days after completion of the new
																																																			 well.
11.
																																																				THAT the granting of this petition will not injure any other appropriators. It
																																																				is the prayer of your petitioner that this petition for change of location of
																																																				the No Name Well as outlined in paragraph 3 above be granted, and that a proper
																																																				Order of the State Board of Control be entered recording same.
Respectfully
																																																				submitted,
_______________
John
																																																				Doe
The
																																																				foregoing instrument was acknowledged before me this ___ day of
																																																				__________________, 20______. Witness my hand and official seal.
__________________
Notarial
																																																				Officer
My Commission expires: _____________________________________
NOTE:
If the well is unadjudicated with beneficial use received, there will be no
																																																				reference to Order Record numbers, Certificate Record numbers and Proof
																																																				numbers.
THE
																																																				FOLLOWING FORM IS TO BE USED TO ACQUIRE CONSENTS FROM THOSE APPROPRIATORS WHO
																																																				COULD POSSIBLY BE AFFECTED BY THE GRANTING OF A PETITION BY THE STATE BOARD OF
																																																				CONTROL. THE FORMAT MAY VARY ACCORDING TO THE TYPE OF PETITION. WHENEVER
																																																				CONSENTS ACCOMPANY A PETITION, EVIDENCE OF OWNERSHIP FOR THE PERSONS GIVING
																																																				CONSENT MUST BE PROVIDED, IF CONSENTING DIVERSION IS NOT LEGALLY
																																																				ORGANIZED.
_____________________________________________________
CONSENT
																																																				TO PETITION FOR CHANGE OF POINT OF DIVERSION AND MEANS OF
																																																				CONVEYANCE
The
																																																				following individuals are all the owners of record of those appropriations
																																																				under the Unnamed Ditch, diverting from No Name Creek. Each of the following
																																																				individuals has read, understands, and gives their consent to the petition of
																																																				John Doe for change of point of diversion and means of conveyance for the J. W.
																																																				Doe Appropriation, Permit No. 3214, Proof No. 1491, for 62.0 acres, to be
																																																				changed from the No Name Ditch to the Unnamed Ditch. Unless this petition is
																																																				amended, the undersigned also hereby waives any further notice
																																																				requirement.
(Signed)
																																																				____________________________________
The
																																																				foregoing instrument was acknowledged before me this day of ________________,
																																																				20_______. Witness my hand and official seal.
__________________
Notarial
																																																				Officer
My
																																																				commission expires:________________________
(Signed)_____________________________________
The
																																																				foregoing instrument was acknowledged before me this day of ________________,
																																																				20_______. Witness my hand and official seal.
____________
Notarial
																																																				Officer
My
																																																				commission expires:________________________
AUTHORIZATION
																																																				TO DETACH WATER RIGHTS FOR
CHANGE
																																																				OF USE OR PLACE OF USE
AND
PETITION
																																																				FOR VOLUNTARY ABANDONMENT OF WATER RIGHTS FORM
I/We____________________________,
																																																				of _____________________________,
(Name
																																																				of Grantor) (Street Address, P.O. Box No. etc.)
City
																																																				of_________ , County of______________ ,
State
																																																				of____________ ,
as
																																																				owner(s) of the following described lands, hereby authorize detachment or
																																																				abandonment by:
____________________________,
																																																				of __________________________________,
(Name
																																																				of Grantee) (Street Address, P.O. Box No. etc.)
City
																																																				of_____________ , County of__________ ,
State
																																																				of___________ ,
of
																																																				the______________ appropriation,
(Appropriation
																																																				Name)
diverting from________________ , through the______________ ,
(Source)
																																																				(Ditch or Pipeline)
Permit
																																																				No.__________ , Priority date of__________________,
for
																																																				irrigation of the following described lands:
T
																																																				.___________N. , R. ______________W .
Section_______
																																																				:________1/4________1/4 acres
Section_______:_________1/4________1/4
																																																				acres
This
																																																				Authorization allows Grantee or his assignee to petition the State Board of
																																																				Control for change of use or place of use of the above described water rights
																																																				attaching to the above described lands as provided for in Section
																																																				
									41-3-104, W.S. 19 77, within five (5) years
																																																				of the date of the acceptance of this Authorization, and petitions that any or
																																																				all of the water rights not so changed be declared voluntarily
																																																				abandoned.
Recent
																																																				historical use, generally the five (5) years previous to the signing of the
																																																				Authorization, and other requirements will be needed to support a petition and
																																																				map to change the use or place of use. If the water rights are to remain in or
																																																				are being placed in a subdivision, a Water Distribution Plan will also be
																																																				required. Until such change or voluntary abandonment is granted by the Board of
																																																				Control, the water rights involved in this Authorization and Petition remain
																																																				attached for the permitted use on the lands described thereon.
Notice to
																																																				successor owners of these lands that this water right will be removed or
																																																				abandoned after five (5) years is the responsibility of Grantor or Grantor's
																																																				successors.
Grantor
																																																				and Grantee hereby waive any and all notices which may be required by law,
																																																				including those required in condemnation proceedings provided by Section
																																																				
									41-3-103, W.S. 1977, as amended, and state
																																																				that neither Grantor nor Grantor's successors or assigns shall, at any time in
																																																				the future, file any adverse claims or institute any proceedings in law or
																																																				equity attacking adversely, or in any manner whatsoever, the equities, right,
																																																				title or interest of any of the water rights herein referred to and for which
																																																				it is hereby agreed that Grantor has received full and adequate
																																																				compensation.
GRANTOR
																																																				AND GRANTEE UNDERSTAND AND AGREE THAT IF NO PETITION FOR CHANGE OF USE OR
																																																				CHANGE OF PLACE OF USE FOR ALL OF THE WATER RIGHTS ATTACHING TO THE ABOVE
																																																				DESCRIBED LANDS IS RECEIVED WITHIN THE FIVE (5) YEAR PERIOD AND SUCH PETITION
																																																				SUBSEQUENTLY GRANTED BY THE BOARD OF CONTROL, GRANTOR AND GRANTEE HEREBY
																																																				REQUEST THAT THE BOARD OF CONTROL ISSUE A PROPER ORDER DECLARING ALL OF THE
																																																				REMAINING WATER RIGHTS ATTACHED TO THE ABOVE DESCRIBED LANDS
																																																				ABANDONED.
An
																																																				unaltered Authorization and Petition Form shall be completed and submitted for
																																																				acceptance, along with evidence of lands ownership, recording fees, and a map
																																																				certified by a professional engineer or land surveyor licensed to practice in
																																																				Wyoming delineating the above lands, to the State Board of Control, Herschler
																																																				Building, 4th Floor East, Cheyenne, Wyoming,
																																																				82002.
________________________(Signed)
___________________________(Grantor)
																																																				The foregoing instrument was acknowledged before me this day ____________, of
																																																				20___________
Witness
																																																				my hand and official seal
______________________
Notarial
																																																				Officer
My commission expires:_____________________
___________________________________________(Signed)
____________________________________________(Grantee)
The
																																																				foregoing instrument was acknowledged before me this day
____________,
																																																				of 20___________ Witness my hand and official seal
____________________
Notarial
																																																				Officer
My commission expires:_________________
_________________________________________________
For
																																																				Office Use Only
_______________
																																																				______________
DATE APPROVED ADJUDICATION OFFICER
APPLICATION
																																																				FOR TEMPORARY CHANGE IN POINT OF DIVERSION
DATE:
																																																				_______________________________________________
Name
																																																				of Applicant:
																																																				_______________________________________________________________________
Address:
																																																				_________________________________________________________________________________
Name
																																																				of Facility: ___________________________ Source:
																																																				___________________________________
Permit
																																																				No.: _________________________________ Priority Date:
																																																				____________________________
Name
																																																				of Appropriation: ______________________Acres under Change____________
																																																				CFS___________
Present
																																																				Point of Diversion: __________1/4_______1/4, Sec. _______, T. __________, R.
																																																				__________
Proposed
																																																				Point of Diversion: _________1/4_______1/4, Sec. _______, T. __________, R.
																																																				__________
Type
																																																				of Change requested:
																																																				________________________________________________________________
Reason
																																																				for Change:
																																																				_______________________________________________________________________
Consents
																																																				for intervening Points of Diversion, if necessary (may be continued on reverse
																																																				side):
Facility
																																																				Signature
_____________________
																																																				___________________________
_____________________
																																																				___________________________
_____________________
																																																				___________________________
_____________________
																																																				___________________________
Intervening
																																																				Sources:______________________________________________________________________
The
																																																				following conditions will apply if this request is granted:
A.
																																																				This irrigation POD change is for _________ water year only, or one year for
																																																				other uses .
B.
																																																				There can be no injury to any other appropriators as a result of this
																																																				change.
C.
																																																				To acquire permission for a
permanent
change in Point
																																																				of Diversion, a Petition must be submitted to the Board of Control (or State
																																																				Engineer if water right is unadjudicated).
D.
																																																				The granting of this temporary change in no way commits the Board of Control or
																																																				State Engineer to approve petition for a permanent change.
E.
																																																				The granting of this temporary change does not constitute the granting of
																																																				right-away.
F.
																																																				This temporary change may be revoked at any time by the Water Commissioner.
___________________________________
Signature
																																																				of Applicant (if available)
Request
																																																				for
TEMPORARY CHANGE IN POINT OF DIVERSION
______________________________________
(granted/denied)
this
																																																				___ day of _______________, 2_____, for the irrigation season of ______________
																																																				only.
__________________________________________
SUPERINTENDENT
																																																				WATER DIVISION
TEMPORARY
																																																				CHANGE IN POINT OF DIVERSION. The division superintendents are authorized to
																																																				use temporary changes in point of diversion (separate form for changes of
																																																				location for ground water wells) up to a maximum of one water year. The
																																																				affected water right must be a valid appropriation. Approval for a temporary
																																																				change shall not be given if there is a likelihood of injury to any other
																																																				appropriator. In no case shall an increase in water use (diversion rate, acres
																																																				irrigated,
area(s) or point (s) of use) by a temporary change be
																																																				allowed. The
superintendents shall forward copies of all temporary
																																																				change requests and approvals to the State Engineer's and Board of Control's
																																																				offices in Cheyenne.
If
																																																				a permanent change is to be requested, a proper petition must be filed with the
																																																				Board during the period of temporary change. The giving of an approval for a
																																																				temporary change does not in any way guarantee that the State Board of Control
																																																				will approve a permanent change.
A
																																																				request for a temporary change must be made on the form and must be approved in
																																																				writing by the appropriate superintendent prior to making the change. (SEE FORM
																																																				ON REVERSE SIDE).
The
																																																				Superintendent, under W.S. W.S.
																																																				W.S.
																																																				41-3-503 through W.S. W.S.
																																																				W.S.
																																																				41-3-506, may allow temporary changes in
																																																				certain instances where necessary for equal and fair distribution of water and
																																																				administration of priorities.
APPLICATION
																																																				FOR
TEMPORARY CHANGE IN LOCATION OF WELL
DATE:
																																																				____________________________________
Name
																																																				of Applicant:
																																																				___________________________________________________________
Address:
																																																				_____________________________________________________________________
Name
																																																				of Well:
																																																				________________________________________________________________
Permit
																																																				No.: ________________________ Priority Date: __________________________
Present
																																																				Location of Well: 1/4_____1/4 Sec. ____, T. _______, R. _______
Proposed
																																																				Location of Well:
1/4
_____1/4 Sec. ____, T. _______,
																																																				R. _______
(The
																																																				proposed relocated well will be approximately ____________ feet ____________
																																																				(direction)of the existing well.)
Is
																																																				this well located within a Ground Water Control Area? _________
Total
																																																				Depth of existing well: ____________ feet
Proposed
																																																				Depth of relocated well: ______________ feet
Reason
																																																				for Change:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
I
																																																				understand that the following conditions will apply if this request is
																																																				granted:
A.
																																																				This change is for the water year ________ only.
B.
																																																				There can be no injury to any other appropriators as a result of this
																																																				change.
C.
																																																				To acquire permission for a permanent change in the location of this well, I
																																																				must submit a Petition to the Board of Control.
D.
																																																				The granting of this temporary change in no way commits the Board of Control or
																																																				State Engineer to approve the petition for a permanent change.
________________________
Signature
																																																				of applicant
Request
																																																				for
TEMPORARY CHANGE IN LOCATION OF WELL
_____________________________
(granted/denied)
this_____________
																																																				day of_______________ , 2__________ , for the irrigation season of only.
_______________________________________
SUPERINTENDENT
																																																				WATER DIVISION ______
TEMPORARY
																																																				CHANGE IN WELL LOCATION. The division superintendents are authorized to use
																																																				temporary changes of location for ground water wells for short periods of time
																																																				(up to a maximum of one year). The affected ground water right must be a valid
																																																				appropriation. If a well is involved which is located in a ground water control
																																																				area, the superintendent may approve the temporary change; however, he should
																																																				consult with the Administrator of the State Engineer's Ground Water Division
																																																				prior to acting on the request. (Recommendation of the Control Area Advisory
																																																				Board will be required prior to approving a permanent change in well location).
																																																				Approval for a temporary change shall not be given if there is a likelihood of
																																																				injury to any other appropriator. In no case shall an increase in water use
																																																				(yield, acres irrigated, area(s) or point(s) of use) by a temporary change be
																																																				allowed. The superintendents shall forward copies of all temporary change
																																																				requests and approvals to the State Engineer' s and Board of Control Offices in
																																																				Cheyenne.
If
																																																				a permanent change is to be requested, a proper petition must be filed with the
																																																				Board during the period of temporary change. The giving of an approval for a
																																																				temporary change does not in any way guarantee that the State Board of Control
																																																				will approve a permanent change.
A
																																																				request for a temporary change must be made on the form and must be approved in
																																																				writing by the appropriate superintendent prior to making the change. (SEE FORM
																																																				ON REVERSE SIDE.)
The
																																																				Superintendent, under W.S. W.S.
																																																				W.S.
																																																				41-3-503 through W.S. W.S.
																																																				W.S.
																																																				41-3-506, may allow temporary changes in
																																																				certain instances where necessary for equal and fair distribution of water and
																																																				administration of priorities.
IMPORTANT
																																																				NOTICE TO APPROPRIATORS
The following condition must be met if a rotation is to be allowed:
1.
																																																				  All appropriations involved must be in priority and entitled to water during
																																																				  the entire rotation period;
2.
																																																					 An actual rotation of water use for the lands under each appropriation is
																																																					 required, and each rotation period will not exceed ten days unless a longer
																																																					 period is agreed to by the hydrographer commissioner or water
																																																					 commissioner;
3.
																																																						The proposed rotation shall not result in injury to other appropriators;
4.
																																																						  The rotation proposed is limited to one season.
NOTICE
																																																						  OF INTENTION TO ROTATE
To: ________________________________ Date: _________________, 2______.
District
																																																						  No. _____, Division No. _________
______________________________,
																																																						  Wyoming
In
																																																						  accordance with W.S. W.S.
																																																						  W.S.
																																																						  41-3-612, you are hereby notified that the
																																																						  undersigned wish to rotate the following water appropriations in the manner and
																																																						  for the time outlined below:
1.
																																																							 Name of Source Amount of
Ditch
																																																							 or Supply Appropriation Priority Owner
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
2.
																																																								Rotation will be commenced on__________,_____ 2____ , and will be accomplished
																																																								as follows: __________________________________________________
__________________________________________________________
__________________________________________________________
DO
																																																								NOT WRITE IN SPACE BELOW - FOR HYDROGRAPHER COMMISSIONER OR WATER COMMISSIONER
																																																								ONLY
Received
																																																								on________ ,2________ . By__________________
District
																																																								No._________ Division No._______________
Remarks:______________________________________________________________________
__________________________________________________________
Approved
																																																								this________ day of____________ , 2_______ .
______________________________
District
																																																								No. _____ Division No. ____
A
																																																								GENERAL REQUIREMENT FOR REQUESTING REGULATION IS THE MAINTENANCE OF A
																																																								SATISFACTORY HEADGATE AND MEASURING DEVICE AT THE LEGALLY-RECORDED DIVERSION
																																																								POINT SO AS TO ENABLE THE HYDROGRAPHER COMMISSIONER OR WATER COMMISSIONER TO
																																																								DETERMINE IF THE REQUEST FOR REGULATION HAS BEEN SATISFIED. IF YOU DO NOT HAVE
																																																								AN APPROVED HEADGATE AND MEASURING DEVICE PRESENTLY INSTALLED, YOUR REQUEST FOR
																																																								REGULATION WILL BE SUBJECT TO REVIEW BY THE HYDROGRAPHER COMMISSIONER OR WATER
																																																								COMMISSIONER AND/OR DIVISION SUPERINTENDENT.
THE
																																																								APPROPRIATOR IS OBLIGATED TO NOTIFY THE HYDROGRAPHER COMMISSIONER OR WATER
																																																								COMMISSIONER PRIOR TO THE DATE WHEN WATER WILL NO LONGER BE USED SO THAT PROPER
																																																								ADJUSTMENTS MAY BE MADE TO AVOID THE WASTE OF WATER.
________________________________________________________
REQUEST
																																																								FOR REGULATION
Pursuant
																																																								to W.S. W.S. 41-3-603,
																																																								41-3-604,
																																																								41-3-606,
																																																								41-3-304 and
																																																								41-3-111 revised statutes 1977, I
																																																								hereby request regulation of _________________
________________________________________________________
and
																																																								tributaries and this requested to supply my (our) appropriation of water
																																																								through the _____________________________________________________
Ditch(es)
																																																								or Reservoir(s) under Permit Nos. ___________________________ ,
																																																								_____________________________________with priority(s)
																																																								of_____________________________ until___________________________________
Signed:_________________
																																																								__________________
________________
																																																								_____________________
________________
																																																								_____________________
Received
																																																								on____________________ , 2________________ .
_________________________________________________
Hydrographer
																																																								Commissioner or Water Commissioner District No. _________, Division No.
																																																								_____
Request
																																																								approved: ___________
Request
																																																								denied: ___________
Comments:________________________________________
_________________________________________________
THE
																																																								FOLLOWING IS A SAMPLE OF A PETITION WHICH CAN BE USED TO FACILITATE RECORDATION
																																																								OF A CHANGE OF POINT OF DIVERSION AND MEANS OF CONVEYANCE THAT OCCURRED PRIOR
																																																								TO 1965.
PETITION
																																																								FOR RECORDATION OF A )
CHANGE
																																																								OF POINT OF DIVERSION )
AND
																																																								MEANS OF CONVEYANCE PRIOR )
TO
																																																								1965 OF THE J. W. DOE )
APPROPRIATION,
																																																								PERMIT NO. ) BEFORE THE
3214,
																																																								DIVERTING FROM NO NAME ) STATE BOARD OF CONTROL
CREEK,
																																																								TRIBUTARY NO NAME ) CHEYENNE, WYOMING
RIVER,
																																																								THROUGH THE NO NAME )
DITCH,
																																																								WITH PRIORITY OF MAY )
16,
																																																								1905, CHANGED TO THE )
UNNAMED
																																																								DITCH. )
O.R.
																																																								2, P. 446; C.R. 3, P. 435; PROOF NO. 3491
STATE
																																																								OF WYOMING )
)
																																																								SS
COUNTY OF FREMONT )
COMES
																																																								NOW John Doe of Box 00, Split Rock, County of Fremont, State of Wyoming, who
																																																								being duly sworn on oath according to law does hereby make the following
																																																								statement of facts and petition:
1.
																																																								  THAT he is the owner of the lands and the appropriation for which a recordation
																																																								  of a change of point of diversion and means of conveyance prior to 1965 is
																																																								  sought, as evidenced by the attached proof of ownership from the County Clerk
																																																								  of Fremont County, Wyoming.
2.
																																																									 THAT the appropriation for which a recordation of a change of point of
																																																									 diversion and means of conveyance prior to 1965 is sought is the J. W. Doe
																																																									 Appropriation, Permit No. 3214, adjudicated under Proof No. 3491, in the amount
																																																									 of 0.89 c.f.s. for the irrigation of 62.0 acres, diverting from No Name Creek,
																																																									 tributary No Name River, through the No Name Ditch (as of record), with
																																																									 priority of May 16, 1905, and of record in Order Record 2, page 446;
																																																									 Certificate Record 3, page 435 describing the lands irrigated as follows:
Township
																																																												30 North, Range
98
																																																												West
Section
																																																												19: SW1/4SW1/4
32.0 acres
SE1/4SW1/4
10.0
Section
																																																												30: NW1/4NW1/4
20.0
Total
62.0 acres (0.89 c.f.s.)
3.
																																																										THAT your petitioner requests a recordation of a change of point of diversion
																																																										and means of conveyance prior to 1965 of the J. W. Doe Appropriation, Permit
																																																										No. 3214, which diverts from No Name Creek through the No Name Ditch (as of
																																																										record), at a point described as North 12° 30' East, 1620.0 feet distant
																																																										from the Southwest Corner of Section 28, Township 30 North, Range 99 West, and
																																																										situated in the SE1/4SW1/4 of Section 28, to the Unnamed Ditch, diverting from
																																																										the same source of supply, under Permit No. 3400, approximately 1/2 mile
																																																										downstream at a point described as North 15° 20' East, 1056.0 feet distant
																																																										from the Southwest Corner of Section 28, Township 30 North, Range 99 West, and
																																																										situated in the SW1/4SW1/4 of Section 28.
The
																																																										lands for which this recordation is requested are described as follows:
Township
																																																												  30 North, Range 98 West
Section
																																																												  19: SW1/4SW1/4
32.0 acres
SE1/4SW1/4
10.0
Section
																																																												  30: NW1/4NW1/4
20.0
Total
62.0
																																																												  acres (0.89 c.f.s.)
4.
																																																										  THAT the reason for the requested recordation is that a portion of the No Name
																																																										  Ditch was subject to washouts and had been difficult to maintain. The change of
																																																										  point of diversion and means of conveyance to the Unnamed Ditch has eliminated
																																																										  this problem and provide a more economical means of conveyance. The petitioner
																																																										  has evidence that this change occurred in 1952 or 1953, and proof that this
																																																										  change occurred at that time accompanies the petition.
5.
																																																											 THAT a map does not accompany this petition, since the new point of diversion
																																																											 has a current and accurate legal survey tie, to a known corner of the public
																																																											 land survey, on file in the State Engineer's Office and/or the State Board of
																																																											 Control, and because the entire appropriation(s) or all permitted acreage
																																																											 within the involved quarter-quarters under this facility has been included in
																																																											 this request.
6.
																																																												THAT the appropriation involved has been diverted at least once in the last
																																																												five years when water was available through the new point of diversion and
																																																												means of conveyance.
7.
																																																												  THAT the granting of this petition has not injured any other appropriators. It
																																																												  is the prayer of your petitioner that this petition for recordation of a change
																																																												  of point of diversion and means of conveyance prior to 1965, as outlined in
																																																												  paragraph 3 above, be allowed without loss of priority, and that a proper Order
																																																												  of the Board be entered recording same.
Respectfully
																																																												  submitted,
___________________
John
																																																												  Doe
The
																																																												  foregoing instrument was acknowledged before me this ___
day
																																																												  of __________________, 20______.
Witness
																																																												  my hand and official seal.
______________________________
Notarial
																																																												  Officer
My Commission expires: _____________________________________