Application: Oil and Gas Conditional Use

A PDF version of this form can be found here: Oil and Gas Conditional Use Tech Form

Project Name(Required)

Property Owner Details

Name of Property Owner(Required)

First Last

Company Name(Required)

Contact Information of Property Owner(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number of Property Owner(Required)

Email of Property Owner(Required)

Signed Affidavit from Property Owner(Required)

Max. file size: 20 MB.

Applicant Details

Name of Applicant(Required)

First Last

Company Name(Required)

Contact Information of Applicant(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number of Applicant(Required)

Email of Applicant(Required)

Property Description

Site Address / Location(Required)

Existing Zoning(Required)

Existing Use(Required)

Proposed Zoning(Required)

Proposed Use(Required)

Purpose of Application(Required)

Application Checkist

Application Fee Amount: $100

Due within 72 hours of submittal by check or after the acceptance of the submittal online at https://www.colorado.gov/payment/townoftimnath

Signed Fee Agreement

Poudre Fire Authority Development Review Fee: $250

*Plus applicable Scope Fees, Refer to PFA Fee Schedule. Due within 72 hours of submittal by check or after the acceptance of the submittal online at https://www.colorado.gov/payment/townoftimnath

Site Plan

Minimum scale 1″ = 50′
Proposed location of site facilities associated with the well in the event production is established, if applicable 1″=50′) and preparation date
Show existing tank batteries and transmission and gathering lines within 660 ft. of the well sitep
Location of layout, include position of the drilling equipment and related facilities and structures
True north arrow
Existing improvements, if any, within a 660 ft. radius of the proposed well
Existing utility easements and other rights-of-way of record within a 660 ft. radius of the well
Existing irrigation or drainage ditches within 400 ft. of the well site or production site
Drainage and erosion control plans for the site and the area immediately adjacent, if applicable
Location of access roads
Well site or production site and existing lease boundaries
Names of abutting subdivisions or owners of abutting, unplatted property within 400 ft. of the site
Name and address of the operator and the name of the person preparing the site plan or map

Vicinity Maps

Location of all existing water bodies and watercourses (including direction of flow) submitted on USGS 7.5 minute series or assessor base maps. Indicate topographic detail and show all existing water bodies and watercourses with a physically defined channel within 400 ft. radius of the well
Location of existing oil and gas wells as reflected in OGCC records, submitted on a map and including any and all wells within a 1,000 ft. radius of the proposed location for the well
Drill site location submitted on a Commission Form 2. Include Parcel Tax Identification Number

Operator’s and Surface Owner’s Names and Addresses

Include copies of any required OGCC Form 2 and designation of agent, if applicable.

Operating Plan

Permits and Approvals

List of all permits/approvals obtained or yet to be obtained from local, state or federal agencies.

Emergency Response Plan, submit to agency prior to application submittal

Must be mutually acceptable to the operator and the appropriate fire district that includes a list of local telephone numbers of public and private entities and individuals to be notified in the event of an emergency, location of the well, and provisions for access by emergency response entities.

Fire Protection Plan, submit to agency prior to application submittal

Must be mutually acceptable to the operator and the appropriate fire district that includes planned actions for possible emergency events and any other pertinent information.

Weed Control Plan

Sanitary Facility Compliance

Must comply with Section 602(g) of the OGCC regulations.

Upload All Required Documents

Drop files here or

Max. file size: 20 MB, Max. files: 20.

Consent

*The Town and Applicant agree to conduct transactions related to submission and review of this application by electronic means, pursuant to the Uniform Transactions Act, Sec. 24-71.3-101, et seq., C.R.S. The Town or the Applicant may refuse to conduct other transactions by electronic means. If the Applicant does not agree to submit the application by electronic means, a physical paper application may be filed with the Town at 4750 Signal Tree Drive, Timnath, CO 80547.

Signature(Required)

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