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U.S. Department of the Interior | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Submit original plus THREE copies, | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28 | Unnamed: 29 | Unnamed: 30 | Unnamed: 31 | Unnamed: 32 | Unnamed: 33 | Unnamed: 34 | Unnamed: 35 | Unnamed: 36 | OMB Control No. 1010-0141
Bureau of Ocean Energy Management, |  |  |  |  |  |  |  |  |  |  |  | with ONE copy marked "Public Information." |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | OMB Approval Expires XX/XX/XXXX
Regulation and Enforcement (BOEMRE)
Application for Permit to [NAME] (APD)
1. | PROPOSAL TO DRILL |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2.  BOEMRE OPERATOR NO. |  |  |  |  |  |  |  |  | 3.  OPERATOR NAME and ADDRESS
 | NEW WELL |  |  |  | SIDETRACK |  |  |  |  | BYPASS |  |  |  | DEEPEN |  |  |  |  |  |  |  |  |  |  |  |  | (Submitting office)
4. WELL [NAME] (CURRENT) |  |  |  |  |  |  |  | 5.  SIDETRACK NO. (CURRENT) |  |  |  |  |  |  |  |  | 6.  BYPASS NO. (CURRENT)
7. PROPOSED START DATE |  |  |  |  |  |  |  | 8. PLAN CONTROL NO. (NEW WELL ONLY)
9. API WELL NO. (CURRENT SIDETRACK / BYPASS) (12 DIGITS)
10. |  | Revision |  |  | 11. | If revision, please list changes:
WELL AT TOTAL DEPTH (PROPOSED) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | WELL AT SURFACE
12. LEASE NO. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 17. LEASE NO.
13. AREA NAME |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 18. AREA NAME
14. BLOCK NO. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 19. BLOCK NO.
15. LATITUDE |  |  |  |  |  |  |  |  |  | 16. LONGITUDE |  |  |  |  |  |  |  |  | 20. LATITUDE |  |  |  |  |  |  |  |  | 21. LONGITUDE
 | (         NAD 83 /           NAD 27) |  |  |  |  |  |  |  |  |  | (         NAD 83 /           NAD 27) |  |  |  |  |  |  |  |  | (         NAD 83 /         NAD 27) |  |  |  |  |  |  |  |  | (         NAD 83 /           NAD 27)
LIST OF SIGNIFICANT MARKERS ANTICIPATED
22. NAME |  |  |  |  |  |  |  |  | 23. TOP (MD) |  |  |  |  | 24. TOP (TVD) |  |  |  |  | 22. NAME |  |  |  |  |  |  |  |  | 23. TOP (MD) |  |  |  |  | 24. TOP (TVD)
25. LIST ALL ATTACHMENTS (Attach complete well prognosis + attachments required by 30 CFR 250.414 or 30 CFR 250.1617(c) and (d) as appropriate.)
26. CONTACT NAME |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 27. CONTACT TELEPHONE NO. |  |  |  |  |  |  |  |  | 28. CONTACT E-MAIL ADDRESS
29.  AUTHORIZING OFFICIAL (Type or print name) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 30.  TITLE
31.  AUTHORIZING SIGNATURE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 32.  DATE
THIS SPACE FOR BOEMRE USE ONLY
APPROVED: |  |  |  |  |  |  |  |  |  |  |  | BY |  |  |  |  |  |  |  |  |  |  |  |  |  | TITLE
 |  | With Attached Conditions
 |  | Without Conditions
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | DATE
API WELL NO. ASSIGNED TO THIS WELL
BOEMRE |  |  | FORM 0123 |  |  |  |  | (Mo/Year - Supersedes all previous versions of Form 0123 which may not be used.) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Page 1 of 2