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This page to be complefed by the local Watermaster. <br />WATER AVAILABILITY STATEMENT <br />Narne of Applicant: Lirnited License Nurnber: <br />1. To your knowledge, has the strearn or basin that is the source for this application ever been regulated <br />for prior rights? <br />^ Yes ^ No <br />If yes, please explain: <br />2. Based on your observations, would there be water available in the quantity and at the times needed to <br />supply the use proposed by tliis application? <br />^ Yes ^ No <br />3. Do you observe this s~ream system during regular fieldwork? <br />^ Yes ^ No <br />If yes, what are your observations for the strearn? <br />4. If the source is a well and if WRD were to determine that there is the potential for substantial <br />interference with nearby. surface water sources, would there still be ground water and sur£ace water <br />available during the time requested and in the amount requested without injury to existing water rights? <br />^ Yes ^ No ^ N/A <br />What, would you recommend for conditions on a limited license that may be issued approving this <br />application? <br />5. Any other recommendations you would like to make? <br />Signature <br />WM District #: Date: <br />Application for Limited Water Use License/3 wz~R <br />