On-line Application Form

ND Department of Trust Lands Application form for: Rights-of-Way, Permits, and Surface Damage Agreements for Well Sites

Please fill in this application as completely as possible to reduce the possibility of delays in reviewing your application. When you submit this form, the information will be sent to the Department of Trust Lands and a copy will also be sent to your email address. Items marked with * are required.

Click below for an example of a completed application for:

If "Yes" then list name(s) and location of well(s) being served. *
(i.e. Kv of electric line, design and type of poles; pipeline diameter, material and use; number and types of cables; etc.)
First & Last Name *
Company Name
Address 1 *
Address 2
City *
State *
Postal Code *
Phone *
Mobile Phone
Email *
Confirm Email *
First & Last Name *
Company Name
Address 1 *
Address 2
City *
State *
Postal Code *
Phone *
Mobile Phone
First & Last Name *
Company Name *
Address 1 *
Address 2
City *
State *
Postal Code *
Phone *
Mobile Phone
Email *
Confirm Email *
First & Last Name *
Company Name *
Address 1 *
Address 2
City *
State *
Postal Code *
Phone *
Mobile Phone
Email *
Confirm Email *
First & Last Name *
Company Name *
Address 1 *
Address 2
City *
State *
Postal Code *
Phone *
Mobile Phone
Email *
Confirm Email *

The General Route Map PDF can be sent by email to djacobs@nd.gov or mailed to Surface Division Rights Of Way,

ND Department of Trust Lands, PO Box 5523, Bismarck, ND 58506-5523.

Survey Plats (must be in PDF form) for all projects should be emailed to djacobs@nd.gov.

Click here for an example of a General Route Map.


1707 North 9th Street | PO Box 5523 | Bismarck, ND 58506-5523 | Telephone: (701)328-2800 | Fax: (701)328-3650

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