Application for Permit to Drill an Original Well Within by oyc99684


									                    Application for Permit to Drill an Original Well
                Within the Corporate Limits of Slaughterville, Oklahoma

DATE OF APPLICATION: _______________________________________________________________

APPLICANT’S NAME:           _______________________________________________________________

HOW WILL WATER BE SUPPLIED TO THE DRILLING RIG? _________________________________


HOW WILL DELETERIOUS SUBSTANCES BE DISPOSED?                       _________________________________



1.   Method of Transportation:      _________________________________________________________

2.   Transporter’s Name:            _________________________________________________________

3.   Name and Location of Disposal Site: ___________________________________________________



1.   A list of the names of all surface owners, tenants or lessees of the surface property, lease owners, life
     tenants, remaindermen and mortgagees on all real property and structures within six hundred and
     sixty (660) feet from the proposed site.

2.   Specifications in detail regarding the amount, weight and size of the conductor pipe and surface pipe
     and the procedures to be used in cementing each. Specifications in detail regarding plugging

3.   Copy of the permit to dispose deleterious substances, indicating the exact location of the disposal

4.   Contract with the owner of the disposal site or proof of ownership of the disposal site.

5.   A statement designating a service agent, the name and address of the person within the State of
     Oklahoma upon whom service of process upon applicant may be made within this State; and in the
     case of any non-resident person who has no such service agent within this state, there shall be
     attached to the application the designation of such a service agent resident in Cleveland County,
     Oklahoma, and a consent that service of summons may be made upon such person in any action to
     enforce any of the obligations of the applicant.

6.   Copy of the approved drilling permit issued by the Oklahoma Corporation Commission.

7.   Any additional or supplemental orders issued by the Oklahoma Corporation Commission pertinent to
     this application.
8.     Staking plat.

9.      Block map of the forty (40) acres surrounding the intended site, indicating thereon the following:

       A. Topographical contour lines
       B. Proposed access road
       C. Location of the drilling site
       D. Residences or other structures within six hundred and sixty (660) feet from the proposed well
       E. Existing oil, gas or fresh water well
       F. Public roads and all right-of-ways within three hundred and thirty (330) feet from the proposed
       G. Platted subdivisions within six hundred and sixty (660) feet from the proposed site.

10.    Filing fee in the amount of $350.00.

11.    Drilling deposit in the amount of $1,000.00.

The undersigned applicant hereby certifies that the information supplied in this application, including all
attachments, is true and correct. By signing this I hereby affirmatively state that an official of the town has
the right of entry on the premises and access to the property where the well is to be drilled, and the right of
entry into the same at reasonable times for the purpose of inspecting the property including but not limited
to drilling operations, pumping, or any other oil and gas related activities.

Signature of Applicant:       ________________________________________________

                              Title: __________________________________________

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