DISTRICT: __________ PIPELINE #:__________
ISSUED: _________ EXPIRES: __________
WITH CONDITIONS
BILLINGS COUNTY
APPLICATION FOR PIPELINE PERMIT
Owner Name: _________________________________________________________________________
Address: _________________________________________________________________________
_________________________________________________________________________
Phone: _________________________________________________________________________
Local Agent
Name: _________________________________________________________________________
Address: _________________________________________________________________________
_________________________________________________________________________
Phone: _________________________________________________________________________
Indicate (X) which of the above should receive the completed permit.
Give the section, township and range of route:
______________________________________________________________________________________
Describe the general use of the pipeline:
______________________________________________________________________________________
The following information must be included with this application before a permit will be approved and issued:
1. A map indicating the pipeline route, any county roads or right-of-ways you intend to use, and compressor stations,
if any.
2. Name and address of the contractor, include his ND contractor license number.
3. Name of contractor bonding company and bond or insurance number.
4. Copies of all easements or letters of consent obtained for private landowners.
5. Proposed dates of commencement ____________ and completion ____________.
6. Size of line (diameter) & type: ___________________________
Length of line: ________________________________________
Pressure: ____________________________________________
COUNTY HIGHWAY DEPARTMENT
CONSTRUCTION IN COUNTY RIGHT-OF-WAY PERMIT
(only fill out this portion if you will be crossing or encroaching on
County Right-of-Way or section lines)
The Board of Billings County Commissioners, in the state of North Dakota, hereby grant permission to
____________________to place, construct and thereafter maintain a pipeline, on County road right-of-way at the
following location(s):
SEC
TWP
RNG
ALONG OR CROSSING COUNTY ROAD
*Attach additional sheets if necessary.
1. The pipeline shall be placed at a minimum depth of ______ inches below the ______ surface of the ground.
2. The pipeline shall be placed under county roads by means of pipe or boring tool pushed under the surface of the
road, at a minimum depth of ________ inches.
3. The bore shall be cased and booted within the road template. If vented, the vent has to be placed off the road
right-of-way, or a minimum of 75’ from the centerline of the road.
5. Above ground fixtures shall be located off the road right-of-way or on the right-of-way line.
6. All trenches and other excavations shall be carefully backfilled in such a manner as to eliminate settlement, and
the surface of the ground shall be returned to its original condition.
7. It is understood and agreed that Billings County will not be liable for any costs in connection with the future
required relocation of the facility due to road improvement.
8. Installation, maintenance, relocation, and removal of said facilities on county right-of-way shall be done in a
manner satisfactory to, and subject to supervision by the County Engineer for the County Highway Department.
9. Billings County shall not be liable for damage to said facilities resulting from reconstruction or maintenance of
the right-of-way. Applicant and/or its successors shall hold the County harmless for injury to persons or damage
to property resulting from the location of said facilities on county right-of-way. Applicant and/or its successors
are responsible for any and all claims of damage, personal injury, or bodily injury that might result from their
activities in crossing any existing road or section line in Billings County. Furthermore, the applicant and/or its
successors agree to indemnify and hold harmless Billings County for any and all claims of damage, either
personal injury or property or any type of claim for damages of any nature whatsoever, whether valid or invalid,
that is made against Billings County on account of the activities conducted by the applying company and/or its
successors in crossing any existing road or section line.
10. Applicant and/or its successors shall promptly remove said facilities from county right-of-way or shall relocate or
adjust said facility, at its sole cost and expense when requested to do so by the County. When the applying
company and/or its successors uses an existing road or section line easement, the applying company shall be
responsible to pay for all costs of moving, relocating, or reconstructing the facility, should Billings County deem
it necessary or advisable, in its sole discretion, to repair or reconstruct existing roads or to build new roads on
section lines or off section lines as allowed by North Dakota State law. Should the applicant and/or its successors
fail to take necessary steps to relocate, or reconstruct its facility, the county may take steps to have the same
accomplished, and the applying company agrees to reimburse the county for all expenses incurred by Billings
County in moving, relocating or reconstruction of the facility so the existing roads may be repaired or
reconstructed, or new roads may be built on the section line or off the section line as allowed by North Dakota
law.
11. If at any time Billings County wants to excavate in this area and if it should require the said facility to be moved,
it will be at the expense of the applying company and/or its successors.
12. Applicant and/or its successors shall repair or replace highway structures and appurtenances, and any existing
facilities located on, over or under highway right-of-way, which may be damaged as a result of the installation
and maintenance of said facilities on highway right-of-way, including but not limited to slumping in of trenches,
collapse of pipe, etc.
13. A GPS’d drawing of proposed location must be placed on file with Billing County Auditor and must show at a
minimum the location of the proposed facility from a section or quarter line, section, township and range where
the said facility will be placed.
14. During construction or when encroaching upon a public roadway the applicant is required to provide proper
signage such as “Roadwork Ahead or Equipment Working.”
15. All permits are valid for one year upon approval by the County Commissioners
Applicant (Representative, Company)______________________________________________________
Applicant Address (Address, City, State, Zip)_______________________________________________
Phone Number(s) of Applicant ________________________________ Fax ______________________
Email _______________________________________________________________________________
AUTHORIZED SIGNATURE _______________________________ TITLE _____________________
**Before Commencement of construction, the applicant must meet with the road superintendent
PERMIT FEE: $100 1
ST
4 CROSSINGS + $25 PER ADDITIONAL CROSSING
$100 (UP TO 4 CROSSINGS) ____________
$25 X _____________ ADDITIONAL CROSSINGS = $_____________ TOTAL $_____________
PLEASE MAKES CHECK(S) PAYABLE TO BILLINGS COUNTY CREDIT CARDS TRANSACTIONS ARE ALSO ACCEPTED
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WEED CONTROL PLAN TO BE SUBMITTED WITH ZONING APPLICATION:_________
BILLINGS COUNTY WEED CONTROL BOARD INSTRUCTIONS:
PO BOX 168 - MEDORA, ND 58645-0168 Include photos or a map of the property
PHONE: (701) 575.2215 Contact the BCWCB for approval of plan
Website: www.bcwcb.com Email: bcweed09@live.com
APPLICANT: Name: ____________________________________________________________________
Phone: ________________ Cell: _____________________ Email: ____________________
OWNER: Same as above Name:______________________________________________
LEGAL DESCRIPTION OF PROPERTY: Parcel Number: __________ - __________ - __________ - _____
Lot: ________________ Block: ______________ Subdivision: _______________ Acreage: __________________
Qtr/Qtr: ____________ Section: ____________ Township:_________________ Range: ___________________
Existing Land Use: ____ __________________ Proposed Land Use: _________ _________________________
The applicant and all interested parties will cooperate to monitor and control the following
invasive and noxious weeds as prescribed by the ND Century Code and Billings County:
Canada Thistle
Diffuse Knapweed
Leafy Spurge
Musk Thistle
Purple Loosestrife (Lythrum)
Russian Knapweed
Spotted Knapweed
Yellow Toadflax
Dalmatian Toadflax
Saltcedar
Palmer Amaranth
Houndstongue
Black Henbane
Common Burdock (wild rhubarb)
Hoary Cress
Absinth Wormwood (American or common wormwood, mugwort, madderwort, or wormwood sage)
Method of Control: Mechanical Chemical_____________________ Biological Other____________
(Check all that apply) (Herbicide)
Area(s) of Concern & Type of Weeds:
Method of Control
Date Treated
_________________________________________________________________________
Signature of Applicant Date
_________________________________________________________________________
Signature of BCWCB Officer Date
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signature
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signature
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BILLINGS COUNTY, ND
TWP/RANGE
DISTRICT
Highway Superintendent
Jeff Iverson 701-575-4661
1
137-100
2
137-101
3
137-102
DISTRICT 3
4
138-100
Jim Arthaud, Commissioner
5
138-101
701-623-4461
6
138-102
7
139-100
FRYBURG
8
139-101
9
139-102
10
140-100
11
140-101
12
140-102
33
MEDORA
13
141-98
14
141-99
15
141-100
DISTRICT 2
16
141-101
Mike Kasian, Commissioner
17
141-102
701-677-5589
18
142-98
19
142-99
20
142-100
21
142-101
22
142-102
23
143-98
24
143-99
25
143-100
DISTRICT 1
26
143-101
Joeseph L. Kessel, Commissioner
27
143-102
701-863-6551
28
144-98
29
144-99
30
144-100
31
144-101
32
144-102