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Supplemental Dam/Reservoir Information Sheet <br />Dam (structure), Reservoir and Watercourse Data <br />A. Type of Storage Reservoir (indicate by checking (�l) all applicable) <br />r on-channel Ii off-channel f existing structure r proposed structure� r exempt structure"" <br />N/A <br />Applicant shall provide a copy of the notice that was mailed to each member of the governing body of each county and municipality in which <br />the reservoir, or any part of the reservoir, will be located as well as copies of the certified mailing cards. <br />��TWC Section 11.143 for uses of water for other than domestic, livestock, or fish and wildlife from an existing, exempt reservoir with a capacity <br />of 200 acre-feet or less. Please complete Paragraph 6 below if proceeding under TWC 11.143. <br />Date of Construction <br />B. Location of Structure No <br />1) Watercourse: <br />2) Location from County Seat: miles in a direction from , <br />County, Texas. <br />Location from nearby town (if other than County Seat): miles in a direction from <br />, a nearby town shown on county highway map. <br />3) Zip Code: <br />4) The dam wilf be/is located in the <br />No. , Abstract No. in _ <br />5) Station on the centerline of the dam is ° <br />Original Survey <br />County, Texas. <br />(bearing), feet <br />(distance) from the corner of Original <br />Survey No. , Abstract No. , in County, Texas, also <br />being at Latitude °N, Longitude °W. (Provide the latitude and longitude <br />coordinates in decimal degrees, to at least six decimal places. Indicate the method used to calculate the diversion point location). <br />C. Reservoir: <br />1) Acre-feet of water impounded by structure at normal maximum operating level: _ <br />2) Surface area in acres of reservoir at normal maximum operating level: <br />D. The drainage area above the dam is acres or square miles. <br />E. Other: <br />1) If this is a U.S. Natural Resources Conservation Service (NRCS) (formerly Soil Conservation <br />Service (SCS)) floodwater-retarding structure, provide the Site No. and watershed <br />project name <br />2) Do you request authorization to close the "ports" or "windows" in the service spillway? <br />r� Yes r� No <br />Form TCEQ-10201 (revised 2/2010) Page 3 <br />Error! Unknown document property name. � 9 <br />