PROJ00455

• Contract/PO #: C153583
• Contractor Name: Ute Water Conservancy District
• Water District: 0
• Bill Number: XB 99-999
• Loan Projects - Doc Type: Feasibility Study

3. Name, address, and telephone number of individual to contact for additional informaCion, if other than stated in No. I
2 above.

4. Provide in the space below a detailed description and/or sketch of the proposed use of Reclamation's land,
right-of-way, easement, or facility. Include physical data and dimensions such as pipe sIzes, line voltages, I
stationIng, etc. (A more detailed drawing or plan may be required, upon request, for attachment to the Right-of-Use
document). Please ignore this requirement if detailed plans, specification., and drawing. are being submitted.

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5. Location of proposed use: Section _______ Township Range _____ Meridian ______- A map or drawinR showing the
approximate location of the proposed use is required. A~2 minute Quadrangle Map or a copied portion i. preferred.

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6. Length of ti.e which use is desired.
submitted.)

years (Reclaaation will determine ti.. aliowed based on information

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1. Anticipated daee ot commencement of inleallation.
document is signed by the United States.)

(Activity cannot coamence until Right-ot-Us.

8. Anticipated date of completion.

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I certify that the information given in this application is true, complete, and correct to the best of .y knowledge and
belief and is given in good faith. I also understand that no activity can comaence until I receive a Right-of-Use I
document signed by the United States.

Date

Signature of Applicant

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Part 3

MANAGING ENTITY

(To be filled out by Managing Entity)

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Reclamation will not proceed with preparation of the Right-of-Use document without approval signature.

Date

Signature of Approval

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Provide in the space below any comments/recommendations/suggestions which should be considered when processing-the
Right-of-Use document. Attach supplemental sheet(s) a. neces.ary.

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