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Geothermal well—Application for permit. Geothermal Application No. _________ State of Idaho Department of Water Resources Application for Permit To Drill for Geothermal Resources 1. Name of applicant _________ Post office address _________ If partnership, joint-venture, association, or unincorporated group, attach names and places of domicile of partners or persons. If corporation, attach list of corporate offices and their place of domicile, and the names and place of domicile of any person owning thirty percent (30%) or greater interest in the corporation. Also give: a. Place of incorporation and date _________ b. Principal place of business _________ c. Location of home office _________ d. Is applicant making application as an agent for another person, corporation or entity? If so, state name, address, and interest of your principal. _________. e. Designation of agent residing in the State of Idaho _________ 2. Location of proposed well _________ _________ ¼ _________ ¼, Section _________, Township _________, Range _________, B.M. Well number or well name _________ 3. Type of well: [ ] Exploration [ ] Production [ ] Injection 4. Well construction: Describe specifically or attach information pertinent to the proposed casing program, and well construction including casing size, thickness, length of conductor, surface and production pipes; proposed grouting procedures, safety devices, valving, and other measures designed to conserve and protect the geothermal resource and ground water of the state. _________. 5. If the proposed well is for exploration or production, explain the means by which you expect to contain and control the resource. (Use additional sheets if necessary.) _________. 6. What is the character and composition of the material you expect to derive from the well? Include parameters such as phase, estimated temperatures, etc. _________. 7. Is this application a part of a program for exploration or development of an already explored geothermal resource? _________. 8. What is the estimated cost of the construction of the well and related uses? Provide a validated financial statement showing the applicant has sufficient financial resources to complete the project. _________. 9. If the proposed development will involve the use of water for purposes other than geothermal uses, has the applicant applied for a permit to appropriate water as prescribed in Chapter 2, Title 42, Idaho Code? _________. 10. List in detail the applicant's previous experience in geothermal resource development. _________. 11. What does the applicant intend to do with waste products, brine or water from the well? _________. 12. Idaho law requires that a bond be filed with the Department indemnifying the State of Idaho, conditional upon the performance of the duties required by the Idaho Geothermal Resources Act and the proper abandonment of any well covered by permit of not less than $10,000 per well, the actual amount set as a condition of the permit. Identify the company that will underwrite your bond and provide confirmation that they will issue such bond upon payment of the necessary fees. _________. _______________ Signature for application
_________ being first duly sworn and on his (her) oath, deposes and says: That he (she) is the applicant in the above matter; that he (she) has read the foregoing application and knows the contents thereof, and the facts therein contained are true as I verily believe. Subscribed and sworn to before me this _________ day of _________, _________. _______________ Notary Public for Idaho Residence: _________ Commission expires: _________ Action of the Director, Department of Water Resources This application has been reviewed in accordance with Title 42, Chapter 40, Idaho Code and is hereby _________, subject to the following limitations and conditions. Date: _________ _______________ Director Cut along this line _______________ Notice of Intent To Drill This portion of the permit must be returned to the Department of Water Resources at least five (5) working days prior to the commencement of drilling operations. Name of applicant _________ Well number _________ Location of well: _________ ¼ _________ ¼, Section _________, Township _________, Range _________, B.M. Date drilling will begin _________, 19__. Date: _________ _______________ Signature
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