Energy Resource Protection Permit Application

ENERGY RESOURCE PROTECTION APPLICATION FOR PERMIT
Pawnee Nation of Oklahoma Division of Natural Resources and Safety Phone: 918.762.3655 | Fax: 918.762.6461 | Email:dnrs@pawneenation.org 301 Agency Road, P.O. Box 470, Pawnee, OK 74058
Pawnee Nation Code of Laws PNC Title XIII
Type of Application

GeneralIndividual
PERMIT TYPE

Oil & Gas Exploratory Permit($1,000)Oil & Gas Drilling Permit($3,000)Oil & Gas Operations Permit($2,000)Hydraulic Fracturing Permit($5,000)Underground Injection Control Permit($1,000)Product Transport Permit($100)Pipeline Permit($1,000)Treatment, Storage, and Disposal Permit($1,000)Methane Emissions/Flaring Permit($5,000)Easement Permit($100)Pawnee Nation Access Permit($25)
Name of Applicant
Name of Operator
Address

Address of Applicant

Street Address Line 2

CityState

Zip
Phone Number
Emergency Phone Number
Email
Allotment Name
Allotment No.
Lease Name
Lease No.
Unit or CA Name
Unit or CA No.
Location of Well/Site Activity at Surface
Location of Proposed Production Zone
T
R
S
County
State
BIA/BLM Bond No.
I certify that I will comply with the terms and conditions of this permit, and all laws and regulations of the Pawnee Nation of Oklahoma
SIGNATURE

Clear
DATE

MonthDayYear
Date
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ENERGY RESOURCE PROTECTION APPLICATION FOR PERMIT