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<br />UNITED STATES
<br />DEPARTMENT OF THE INTERIOR
<br />BUREAU OF LAND MANAGEMENT
<br />
<br />FORM APPROVED
<br />O"U NO. -4l-R0996
<br />
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<br />
<br />Setld Numb.r
<br />
<br />()- 271
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<br />SPECIAL LAND-USE APPLICATION AND PERMIT
<br />APPLICATION
<br />
<br />INSTRUCTIONS ON REVERSE
<br />
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<br />
<br />I. Name (/i,SI, middle initial, allti ltut) Addresa (irrc:/ude zip roil.)
<br />STATE OF UTAH. DEPT. OF NATURAL RESOURCES
<br />D SION OF WA R RESOURCES 435 STATE CAPITO~ BLDG., S.L.C., UTAH 84114
<br />2. GIVe leeal dellcription of public !and. for which you are spplyinl
<br />
<br />SEenON'
<br />
<br />SUBDIVISION
<br />
<br /> TOWNSHIP RANGE
<br /> !OS 24E
<br /> 105 24E
<br /> 105 24E
<br /> 10S 24E
<br /> as 25E
<br /> as 24E
<br /> 9S 24E
<br />"
<br />\ Veridian
<br />SLB&M
<br />
<br />33. 34
<br />
<br />All
<br />All
<br />All
<br />
<br />Quarters }
<br />quarters
<br />Quarter
<br />Quarter
<br />
<br />}
<br />
<br />Dam site and borrow
<br />area investigation.
<br />
<br />17
<br />21
<br />20
<br />8
<br />
<br />NE, SE, sw:
<br />NW,NE
<br />NE
<br />SE
<br />
<br />. .:'
<br />
<br />16-20. 30, 31
<br />1:2, 13. 23-21,
<br />12. 13
<br />
<br />Gravel material
<br />investigation, only.
<br />
<br />Stare
<br />
<br />COWl.ty
<br />
<br />Acre. (lIulllb...)
<br />Parts of 22 Sections
<br />
<br />Utah
<br />
<br />Uintah
<br />18 months
<br />
<br />3. For how lrnIny years are you requesttnl thiB permit?
<br />
<br />48. ke you 21 yellrs of aae or over?
<br />OV~ ONo N.A.
<br />
<br />b. Are you III citizen of the United States or have you declared
<br />your intention? 0 Yes D No N.A.
<br />
<br />c. As applicIIDt. are you III 0 Plllrtnerahip
<br />or an agency of 0 Fede...1 Government
<br />
<br />o Association D Corporation;
<br />(i] State Government 0 Political subdivision of Bny state?
<br />
<br />d. Are the statements required by Instruction Number 2 attached? 0 Yea D No [i] Not applicable
<br />
<br />....
<br />
<br />6.
<br />
<br />ke the lands now improved. occupied. or used?
<br />poses. ident.ify IIsers and occupants)
<br />
<br />o V..
<br />
<br />[IJ No
<br />
<br />(II "yes." describe improvements and pur-
<br />
<br />I
<br />
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<br />
<br />5.
<br />
<br />Are you making this application for yow own use and benefit?
<br />
<br />[i] Yes D No (II "no." expll1.in)
<br />
<br />Hovever,_there are existing
<br />SouthaM Canyon. These plus
<br />attached maps.
<br />
<br />access roads to these areas vis Wagonhound Canyon and
<br />additional access trails needed are shown on the
<br />
<br />What do you propose to use-the lands for? Exploratory drilling (2-3 holes on U.S.A. land) to
<br />determine aub-surface conditions for dam site determination and planning dam and
<br />reservoir construction; and the digging of teat pits (10-20 on U.S.A. land) by backhoe
<br />to determine borrow areas. All test pits and drill holes will be re-covered after-
<br />wards. Some uae will be accesa only across U.S.A. land to reach private land with
<br />drilling rig and backhoe tractor. Drill holea are 3-inch diameter and between
<br />100-400 feet deep. Drill rig is rubber-tired. Backhoe tractor is rubbe~-t1red and
<br />.111 dl& ~lLD 2" A 6" A 12' d~~~.
<br />b. What illlprovelllents. includinr; aanitation faciliti.es, do you intend to mllke? (Describe improvements. and l1.ltl1.ch
<br />Jrl1.utings. il co"v.mient)
<br />
<br />7..
<br />
<br />None
<br />
<br />'. \
<br />"
<br />
<br />/
<br />
<br />What is the estimated
<br />c. C05t 01. proposed improve-
<br />!Dent? S
<br />
<br />d. What i. the proposed 80urce of .ater for dOflleatic or other use.?
<br />
<br />N.A.
<br />
<br />Drilling water to be pumped from White River.
<br />
<br />B.
<br />
<br />Have you encl~ed filiol fee of $10? D Yea: [jJ No (5.. 'f1s1~cti07J Nllmber 3)
<br />
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<br />I CERTIFY That the lnlorlllatioo. Kiven by me ia this applicatiOll i. true, complete. and correct to the best 01. my
<br />bowled,s Md belief ai1d ill livell. ia load faith.
<br />
<br />Tilly 1 1 Q7'\
<br />(Date) (9icn-ture of Applicant)
<br />Title II V.S.C. See LIon 1001. ...kea it e c:r~a low aay penon Imowlnily lad .UUull, to IlIsJr.e to ea, deparl:lllent Or allenc:y 0'
<br />llnJled States ell' falae, IlcUUous. 01' freuduleAl alat81l1eala Or repnulllaUop a, to 'ay IlIltter within U. Jurisdletion.
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