EXTENSION REQUEST FORM
INSTRUCTIONS (Please Read):
===> You may either print out a blank form or fill in the text areas below and print the form with your responses.
PLEASE NOTE: This form is NOT to be used for title update or address correction.
1. Use the boxes below to describe all appurtenant information. (This will be reviewed and may determine the action of the
State Engineer regarding your Extension Request.)
2. Provide a reasonable and serious approximate date when the project will be completed.
3. Generate Form by pressing "Generate Printable Form."
4. Sign the form.
5. If you have additional supporting documentation, please attach.
6. The filing fee for an extension request is $50 if made before 14 years from the Approval Date, and $150 after that.
To determine which fee is required, refer to the top of the printed form.
7. Enclose the appropriate fee (check or money order made out to "Utah Water Rights") with the extension request and mail or hand
deliver to the Division of Water Rights, 1594 West North Temple, Suite 220, Salt Lake City, UT 84116.
The Adobe reader is required to print the EXTENSION form. It can be acquired at the following link:
Water Right, Change, or Exchange Number:
1. Construction completed to date:
2. Work completed since last extension:
3. Reasons why the project has not been completed:
4. Estimated time for completion of project: