Plum Creek Conservation District
P.O. Box 328

Lockhart, Texas 78644 (512) 398-2383 FAX(512) 398-7776 info@pccd.org

Easement Use Application
Instructions: This form is used for application for modification of easement use and shall be filled out ascompletely as possible.

Landowners Contact Information
Landowner:_____________________________________________________________________________

Mailing Address:_____________________________________________________________________________(Street or P.O. Box)

(City)(State)(Zip)

Phone: ________________________________ Alternate Phone: ______________________
Email Address: ____________________________________________Engineering Contact Information
Engineering Firm: ________________________________________________________________________Primary Engineer: _____________________________________________________________________________
Mailing Address:_____________________________________________________________________________(Street or P.O. Box)

(City)(State)(Zip)

Phone: ________________________________ Alternate Phone: ______________________
Email Address: ____________________________________________

Location, and Land Construction Information
Physical Address of Property: _____________________________________________________________________(Street)(City)(Zip)

The location of property and work to be performed on the property (Example North Corner or GPS Quadrants):__________________________________________________________________________________________________________________________________________________________________________________________
Survey Information:
Survey Name:

Survey #:Abstract #: ____________

Attached Survey_________
Type of Construction or Request:
Fence_____ Septic System_______ Water Line______ Power Line_______ Easement Road_______
Home Construction_______ Subdivision______ Restatement of Easement by Metes and Bound Description_______
Other (If other please specify below)________ Additional Space Needed and Attachment.
_____________________________________________________________________________________________1.

__________________________________________________________________________________________________________________________________________________________________________________________See (“Easement Use Rules” document for needed attachments and additional information)
Name of Contractor and Business Name:_____________________________________________
Contractor Phone Number:__________________________________________________________
Projected Date of Construction to begin: _____________________________________
Has the development been designed by a licensed engineer: Yes____ No____Has the development or designs been approved by the County, City or State: Yes____ No____ If so please provide
and attach details and any approval documents.
_____________________________________________________________________________________________At what stage are the design plans? (30%, 60%, 90%):__________________________________________________

Describe scope of work to be completed within the easement boundaries or any addition information about thisproject:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

List of Attachments:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2.

Easement Use Application Checklist
1. _______ A written description of the proposed construction, filling, excavations, ordevelopment.
2. ________ Locations of any proposed fencing.
3. _______ A map showing the landowners property and the area covered by the Districts
Easements.
4. ________ A copy of the approved, proposed, or pending plat or development
plans.(elevations, roads, buildings, subsurface structures, excavations, fillingsin the easement)
5. _________ If applicable a set of the Drainage Plans and/or hydrological studies
6. ________ Cross sections, copy of cut/fill calculations and a summary of volumes
proposed if applicable
7. ________ Copy of City or Flood Plain Development Permit Applications.
If not required, a representation that no applications are required.
8. __________ Tax certificate from the County Tax Assessor-Collector showing that all real
property taxes are paid on the subject property9. _________ Time schedule indicating a start date and a completion date of the proposed work.
If for an easement area modification or release a proposed date for action by
the Board of PCCD.
10. _________ I have read the following 2 documents. 1. PCCD Easement Use Rules 2.
Easement Use Policy.
11. _________ I have attached all the required documents set forth by the Easement Use Policy
for my completed application.
12. _________ If the application is for construction, excavation, filling, modification orDevelopment activity within easement then a statement of acknowledgment
as detailed on page 5 under item 3- 9th bullet point)
13. _________ If applicable please attach a meets and bound survey of the proposed amendedeasements.
14. ________ Provide a draft of a recordable release and indemnification document. Please
See number 4 under Easement Area Modification Requests page 5 and 6

3.

Additional APPLICATION checklist for easement restatement,modification, release or partialrelease.
1.

________ A statement of the basis for the request detailing calculations showing that theexisting easement in the area of or to the elevation of the proposed modification
or release is no longer required for the operation of the flood control project.

2.

________ A survey showing the proposed easement elevation or modification or the area
proposed to be released relative to the District’s flood control easement area andspecifying land surface elevations in the area proposed for release as well as theelevation of the top of nearest downstream dam. Such survey shall bear the sealof a Registered Professional Surveyor of the State of Texas.

3.

________ If the request is being submitted in conjunction with a proposed or planned
subdivision of the property covered by the PCCD easement, then a copy of the
proposed subdivision plat or a metes and bounds descriptions of the property
before and after the proposed subdivision including a depiction of the location of
the PCCD easements prepared by and bearing the seal of a registered land
surveyor will also need to be provided.

4.

________ A suggested recordable form for the easement modification or release if there isan application to modify or release all or a part of a PCCD easement covering aparticular property. This document should be in a format that is acceptable toCaldwell and/or Hays County for recording, and will need to be approved by theDistrict’s Attorney and the regional office of NRCS.

*Additional information may be requested by the district.
Owner or Registrant’s Sworn Statement
I hereby swear and affirm that the information given herein is true and accurate to the best of my knowledge
and belief, and that I am aware of, knowledgeable of, and will comply with all District Rules.
_____________________________________________________________
Owner’s Applicant’s Signature4.

_________________________
Date