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Home My WebLink AboutDDW-2024-012364DRILLER (START) CARD for Change Application: a50740(25-11930)DUPLICATE/REISSUED IMPORTANT: THIS CARD MUST BE RECEIVED BY THE DIVISION OF WATER RIGHTS PRIOR TO THE BEGINNING OF WELL CONSTRUCTION -- REQUIRED FOR WELLS DEEPER THAN 30 PROOF DUE/EXPIRATION DATE: November 30, 2030 START CARDS CAN BE SUBMITTED ONLINE WITH THE WATER RIGHT NUMBER OR NON-PRODUCTION WELL NUMBER AND THE PIN. ONLINE SUBMISSION WATER RIGHT: a50740 ONLINE SUBMISSION PIN: 546728 ONLINE SUBMISSION URL: http://waterrights.utah.gov/welldrilling/startcardOnline.asp OWNER/APPLICANT: _____________________________________________________________________________ CC Ranch Family LLC MAILING ADDRESS: ______________________________________________________________________________ 4014 West 2600 North, Benson UT 84335 PHONE NUMBER: ________________________________________________________________________________ -- WELL LOCATION: ________________________________________________________________________________ N 1294' E 852' from W4 Cor, S23, T14N , R 1E, SLB&M WELL UTM COORDINATES: ________________________________________________________________________ Easting: 432528 Northing: 4643807 WELL ACTIVITY: NEW(X) REPLACE( ) REPAIR( ) DEEPEN( ) PROPOSED START DATE: _________________________________________________________________________ PROJECTED COMPLETION DATE: __________________________________________________________________ LICENSE #: __________LICENSEE/COMPANY: ________________________________________________________ ________________________________________________ ______________________________________ Licensee Signature Date NOTICE TO APPLICANT: THIS CARD IS TO BE GIVEN TO A UTAH-LICENSED WATER WELL DRILLER FOR SUBMITTAL TO THE DIVISION OF WATER RIGHTS PRIOR TO WELL CONSTRUCTION. STATE OF UTAH DIVISION OF WATER RIGHTS Phone No. 801-538-7416 - FAX No. 801-538-7467 COMMENTS: ____________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ START CARDS MAY ALSO SUBMITTED BY PHONE*, FAX, OR EMAIL. PHONE: 801-538-7416 - FAX: 801-538-7467 - EMAIL: waterrights_wells@utah.gov *IF THE START CARD IS PHONED IN, THEN THE COMPLETED AND SIGNED START CARD MUST BE RETURNED TO THE DIVISION OF WATER RIGHTS BY FAX. EMAIL, OR MAIL. *** FOR OFFICE USE ONLY *** WIN: WELL LOG SENT: APPLICANT CARD for Change Application: a50740(25-11930)DUPLICATE/REISSUED IMPORTANT: THIS CARD MUST BE COMPLETED, SIGNED AND RETURNED BY THE WELL OWNER/APPLICANT AS SOON AS THE WELL IS DRILLED BY A LICENSED UTAH WELL DRILLER. PROOF DUE/EXPIRATION DATE: November 30, 2030 OWNER/APPLICANT: _____________________________________________________________________________ CC Ranch Family LLC MAILING ADDRESS: ______________________________________________________________________________ 4014 West 2600 North, Benson UT 84335 PHONE NUMBER: ________________________________________________________________________________ -- WELL LOCATION: ________________________________________________________________________________ N 1294' E 852' from W4 Cor, S23, T14N , R 1E, SLB&M WELL UTM COORDINATES: ________________________________________________________________________ Easting: 432528 Northing: 4643807 WELL ACTIVITY: NEW(X) REPLACE( ) REPAIR( ) DEEPEN( ) WELL COMPLETION DATE: ________________________________________________________________________ NAME OF DRILLING COMPANY/LICENSEE: __________________________________________________________ ________________________________________________ ______________________________________ Owner/Applicant Signature Date NOTICE TO APPLICANT: COMPLETE AND RETURN THIS PORTION UPON FINAL WELL COMPLETION. DO NOT GIVE THIS CARD TO LICENSED WELL DRILLER. - YOU MUST RETURN IT. STATE OF UTAH DIVISION OF WATER RIGHTS Phone No. 801-538-7416 - FAX No. 801-538-7467 COMMENTS: ____________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ START/APPLICANT CARD INSTRUCTIONS:First, for each well, you must give a Driller (Start) Card to licensed driller with whom you contract to construct your well. Second, it is your responsibility to sign and return this Applicant Card to this office immediately after completion of the well. CAUTION: There may be local health requirements for the actual siting of your well. Please check with the proper local authority before construction begins. See enclosed sheet addressing construction information. *** FOR OFFICE USE ONLY *** WIN: PROCESS DATE: