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Fq1% = Texas Commission on Environmental Qualit <br />PO Box 13087, MC -160, Austin, Texas 78711 -3087 <br />� <br />� Telephone (512) 239 -4691, FAX (512) 239 -4770 <br />TCEQAPPLICATION FOR AMENDMENT TO A WATER RIGHT <br />Notice: This form will not be processed until all delinquent fees and /or penalties owed to the TCEQ or the Office <br />of the Attorney General on behalf of the TCEQ are paid in accordance with the Delinquent Fee and Penalty <br />Protocol. <br />Customer Reference Number (if issued): CN <br />Note: If you do not have a Customer Reference Number, complete Section II of the Core Data Form (TCEQ- 10400) and submit it with this application. <br />Name: City of Paris, Texas <br />Address: P.O. Box 9037 <br />Paris, Texas 75461 -9037 <br />Phone Number: 903 - 784 -9201 <br />Email Address: jgodwinAparistexas.gov <br />2. Applicant owes fees or penalties? <br />rl Yes rI No <br />Fax Number: 903 - 785 -8519 <br />If yes, provide the amount and the nature of the fee or penalty as well as any identifying number: <br />3. 17-1 Permit No. i✓ Certificate of Adjudication No. 02 -4940A <br />Stream: Sanders Creek Tributary of Red River Watershed: Red River Basin and Sulphur River Basin <br />Reservoir (present condition, if one exists): Pat Mayse Reservoir (good) <br />County: Lamar <br />4. Proposed Changes To Water Right Authorizations: <br />This application seeks to amend Certificate of Adjudication No. 02 -4940A to add an agricultural <br />purpose of use to the existing authorization in that appropriation. <br />(Attach additional page as necessary, attach map /plat depicting project location, diversion point, place of use, and other pertinent data). <br />5. 1 understand the Agency may require additional information in regard to the requested amendment before <br />considering this application. <br />Name (sign) <br />Name (print) <br />Name (sign) <br />John Godwin, City Manager <br />Name (print) <br />Subscribed and sworn to me as being true and correct before me this day of <br />20 <br />Notary Public, State of Texas <br />Form TCEQ -10201 (revised 2/2010) Page 1 <br />Error! Unknown document property name. <br />