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Home My WebLink AboutDDW-2025-002934DRILLER (START) CARD for Change Application: a52641(15-5782) IMPORTANT: THIS CARD MUST BE RECEIVED BY THE DIVISION OF WATER RIGHTS PRIOR TO THE BEGINNING OF WELL CONSTRUCTION. PROOF DUE/EXPIRATION DATE: September 25, 2025 START CARDS CAN BE SUBMITTED ONLINE WITH THE WATER RIGHT NUMBER OR NON-PRODUCTION WELL NUMBER AND THE PIN. ONLINE SUBMISSION WATER RIGHT: a52641 ONLINE SUBMISSION PIN: 569702 ONLINE SUBMISSION URL: http://waterrights.utah.gov/welldrilling/startcardOnline.asp OWNER/APPLICANT: _____________________________________________________________________________ Town of Stockton MAILING ADDRESS: ______________________________________________________________________________ PO Box 240, 18 North Johnson Street Stockton UT 84071 PHONE NUMBER: ________________________________________________________________________________ 435-244-9783 WELL LOCATION: ________________________________________________________________________________ N 135' W 2315' from E4 Cor, S32, T 4S , R 4W, SLB&M WELL UTM COORDINATES: ________________________________________________________________________ Easting: 388028 Northing: 4476254 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: a52641(15-5782) 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: September 25, 2025 OWNER/APPLICANT: _____________________________________________________________________________ Town of Stockton MAILING ADDRESS: ______________________________________________________________________________ PO Box 240, 18 North Johnson Street Stockton UT 84071 PHONE NUMBER: ________________________________________________________________________________ 435-244-9783 WELL LOCATION: ________________________________________________________________________________ N 135' W 2315' from E4 Cor, S32, T 4S , R 4W, SLB&M WELL UTM COORDINATES: ________________________________________________________________________ Easting: 388028 Northing: 4476254 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: