Disturbance type
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Well Pad
New Access Road
Existing Access Road
Pipeline
Other
Describe
Surface Owner
BIA (Bureau of Indian Affairs)
BLM (Bureau of Land Management)
BOR (Bureau of Reclamation)
COE (Corps of Engineers)
Fee
Military
State
USFS (U.S. Forest Service)
USFWS (U.S. Fish and Wildlife Service)
Other
BIA Local Office
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Drop-down List Item 1
Drop-down List Item 2
Drop-down List Item 3
BLM Local Office
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Drop-down List Item 1
Drop-down List Item 2
Drop-down List Item 3
BOR Local Office
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Drop-down List Item 1
Drop-down List Item 2
Drop-down List Item 3
COE Local Office
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Drop-down List Item 1
Drop-down List Item 2
Drop-down List Item 3
Fee Owner Name
Fee Owner Address
Fee Owner Phone
Fee Owner Email Address
Surface use plan certification
Yes
No
Surface access agreement or bond?
Agreement
Bond
Surface Access Agreement Need description
Is Surface Access Bond BLM or Forest Service?
BLM
USFS
BLM Surface Access Bond number
USFS Surface access bond number
USFS Surface access bond attachement
show file
USFS Forest/Grassland
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Drop-down List Item 1
Drop-down List Item 2
Drop-down List Item 3
USFS Ranger District
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Drop-down List Item 1
Drop-down List Item 2
Drop-down List Item 3
Other surface owner description