RIGHT OF WAY APPLICATION- CCWDRC.PDF

RETURN TO:
DEPARTMENTAL USE ONLY ROLODEX #_______________
ARIZONA STATE LAND DEPARTMENT
ACCOUNTING T&C RECOMMENDATION/INITIAL DATE
PUBLIC COUNTER
1616 WEST ADAMS Filing Fee:
PHOENIX, ARIZONA 85007 Exam: _______________ Approve _____________ _____________
New/Renewal: $500
SUBMIT NON-REFUNDABLE FILING FEE: Exam #: ______________ Deny _____________ _____________
New/Renewal: $500
Amend: $100 Int Title: _____________ Reject _____________ _____________
Amend: $100
N(34) R(35) A(23) App Entry: ___________ Withdraw_____________ ______________
APPLICATION FOR RIGHT OF WAY
Type or print in ink.
APPLICATION NO. ________-________________________
Complete ALL questions, SIGN and SUBMIT application with appropriate NON-REFUNDABLE FILING FEE.
1. APPLICANT: 2. TYPE OF APPLICATION:
MARICOPA COUNTY
Name X NEW
RENEW
301 WEST JEFFERSON, SUITE 960
Mailing Address AMEND
PHOENIX AZ 85003
Reason for amendment:
City State Zip
DENNIS LINDSEY (602) 506-1067
Contact Person Phone No.
dennis.lindsey@mail.maricopa.gov
Email Address for Contact Person
3. REQUEST FOR RIGHT OF WAY: Applicant hereby makes Right of Way application under A.R.S. § 37-461, for the purpose of
ACCESS ROAD 10
_______________________________________________________________over and across the lands hereinafter described for a term of _____________
years, in accordance with the laws of the State of Arizona and the rules of the State Land Department.
4. LEGAL DESCRIPTION: (Complete below and attach metes and bounds legal description, maps, surveys & plans)
SLD USE ONLY
TWN. RNG. SEC. LEGAL DESCRIPTION ACRES COUNTY CTY GRT PARCEL
5N 4E 7 E. 40' of Lot 1, except N 100' 1.12 MC
_____ _____ _____ _______________________________________________ ________ _________ ________ ________ _________
_____ _____ _____ _______________________________________________ ________ _________ ________ ________ _________
_____ _____ _____ _______________________________________________ ________ _________ ________ ________ _________
_____ _____ _____ _______________________________________________ ________ _________ ________ ________ _________
_____ _____ _____ _______________________________________________ ________ _________ ________ ________ _________
_____ _____ _____ _______________________________________________ ________ _________ ________ ________ _________
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6111-03/92 (Rev. 8/2011) RW

5. CONSTRUCTION SCHEDULE:
a. If construction is required, when is the proposed construction anticipated to begin? __________ No construction
b. Typical processing time for an application is 12-16 months. Does your construction schedule allow for this processing
time? □ No □ x Yes If no, please complete R/W Supplement “RW-CO” Conditional Right of Way Supplement.
6. TYPE OF RIGHT OF WAY – REQUIRED SUPPLEMENTS: (Complete supplement for each use marked)
Required supplements are available at 1616 W. Adams or online at www.land.state.az.us
a. Municipal/Utility Rights of Way
____ Public Roadway & Underground Utilities – (Complete supplement “RW-RU”)
____ Public Roadway – (Complete supplement “RW-R”)
____ Drainage Easement – (Complete supplement “RW-D”)
____ X Service Road – (Complete supplement “RW-R”)
____ Underground Utility Easement – (Complete supplement “RW-U”)
____ Water Line, Reservoir or Lift Station – (Complete supplement “RW-U”)
____ Sewer Line or Lift Station – (Complete supplement “RW-U”)
____ Electrical Line or Substation – (Complete supplement “RW-U”)
____ Gas Line – (Complete supplement “RW-U”)
____ Temporary Construction Easement – (Complete supplement “RW-T”)
_____ Other, Please specify_____________________________________________________
b. Telecommunications Rights of Way
____ Communication Line – Distribution Line – (Complete supplement “RW-C”)
____ Communication Line – Single User – Transmission Corridor – (Complete supplement “RW-C”)
____ Communication Line – Multiple User – Transmission Corridor – (Complete supplement “RW-C”)
____ Service Road – (Complete supplement “RW-R”)
____ Temporary Construction Easement – (Complete supplement “RW-T”)
_____ Other, Please specify_____________________________________________________
c. Private Individuals & Entities
____ Non-Exclusive Access Road – (Complete supplement “RW-R”)
____ Haul Road – (Complete supplement “RW-R”)
x
____ Service Road – (Complete supplement “RW-R”)
____ Temporary Construction Easement – (Complete supplement “RW-T”)
_____ Other, Please specify_____________________________________________________
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6111-03/92 (Rev. 8/2011) RW

7. BASIS FOR APPLICATION:
a. Why are you applying for this right of way? (Mark all that apply):
____ Public Works Project ____ Pending Sale
____ Pending Private Development ____ Loss of Alternative Access
____ Required by City, County, etc. ____ Other, Please specify:
____ Necessary to provide infrastructure ____________________________
____ x Necessary to provide access ____________________________
____ Trespass/Encroachment ____________________________
b. Does this right of way serve a specific property?
□ No If no, complete R/W Supplement “RW-2” (Easement in Gross Supplement)
□ X Yes If yes, complete R/W Supplement “RW-1” (Dominant Estate Supplement)
c. Is the proposed right of way to be used in conjunction with any application for a state lease, permit or sale
(commercial, mineral, etc.)? □ No □ X Yes If yes, provide the application number:__________________ 14-113822
8. EXISTING LESSEE – IMPROVEMENTS:
a. Are there any improvements that would be disturbed if this application is approved (water tanks, wells, fences,
building, etc.)? □ x No □ Yes If yes, list below:
Existing fence and gate will remain
___________________________________________________________________________________________________
___________________________________________________________________________________________________
b. If approved, will the construction and the maintenance of the right of way interfere with or intrude upon the existing
lessee's rights under any existing lease? X □ No □ Yes If yes, describe in detail:
________________________________________________________________________________________________
________________________________________________________________________________________________
c. Have you contacted the Lessee to discuss this application? □ X No □ Yes □ N/A
9. JURISDICTIONAL WASHES:
a. Will the right of way cross any known washes, waterways, or other Waters of the U.S.? □ X No □ Yes If yes, list the
numbered washes or indicate “unnamed wash” below:
________________________________________________________________________________________________
________________________________________________________________________________________________
10. APPLICANT COMPLETE AND SIGN PAGE 4.
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6111-03/92 (Rev. 8/2011) RW

CERTIFICATION: Pursuant to A.R.S. Title 37 and the Rules of the Arizona State Land Department, A.A.C. Title 12,
Chapter 5, you must complete the following information pertinent to you and/or the organization you represent and sign the
certification or your application will not be processed. NOTE: Applicant must complete item #1.
1. Is this application made in the name of: (Applicant must check one) ________Individual(s) ________Husband & Wife
________Corporation ________Partnership ________Ltd. Partnership ________Estate ________Trust ________Ltd. Liability Co.
________Joint Venture ________Municipality ________Political X Subdivision ________Other (specify)______________________________
2. INDIVIDUAL(s) OR HUSBAND & WIFE: Complete the following for each applicant:
NAME AGE MARITAL STATUS
_______________________________________________________ ______ _______________________________________________________
_______________________________________________________ ______ _______________________________________________________
3. CORPORATION: Complete the following:
(A) Do you have authority from the Arizona Corporation Commission to do business in the State of Arizona? Yes____ No____
(B) Is the corporation presently in good standing with the Arizona Corporation Commission? Yes____ No____
(C) In what state are you incorporated? ___________________________________________
(D) Is the legal corporate name and Arizona business address the same as stated in this application? Yes____ No____
If no, state the Legal Corporate Name: _______________________________________________________________________________________________
Address: ________________________________________________________________________________________________________________________
(Street or Box Number) (City) (State) (Zip)
4. LIMITED LIABILITY COMPANY: Complete the following:
(A) If an out-of-state limited liability company: Have you filed for a Certificate of Registration with the Arizona Corporation Commission?
_______Yes _______No
(B) If an Arizona limited liability company: Have you filed Articles of Organization with the Arizona Corporation Commission?
_______Yes _______No
(C) Are you authorized by the Arizona Corporation Commission to transact business in Arizona? _______Yes _______No
5. PARTNERSHIP OR JOINT VENTURE: Complete the following for each authorized partner or principal in the partnership or joint venture:
NAME BUSINESS ADDRESS AGE MARITAL STATUS
____________________________ _________________________________________________ __________ _________________________
____________________________ _________________________________________________ __________ _________________________
6. LIMITED PARTNERSHIP: Is this Limited Partnership on file with the Arizona Secretary of State? Yes No
Complete the following for the authorized general partner(s) only:
GENERAL PARTNER(S) NAME BUSINESS ADDRESS
______________________________________________ ___________________________________________________________________________
______________________________________________ ___________________________________________________________________________
7. ESTATE: Complete the following and attach a copy of the court or estate document(s):
Name of the court-appointed administrator or personal representative: _______________________________________________________________
List the type and date of issuance of the court or Estate document: ___________________________________________________________________
(Date issued) (Type of Document)
8. TRUST: (A) Complete the following pursuant to A.R.S. § 33-404, for each beneficiary of the Trust:
NAME ADDRESS AGE MARITAL STATUS
_______________________ ________________________________________________ ___________ ______________________________
_______________________ ________________________________________________ ___________ ______________________________
or (B) Identify the Trust document by title, document number, and county where document is recorded: ____________________________________
9. I HEREBY CERTIFY, UNDER PENALTY OF PERJURY, THAT THE INFORMATION AND STATEMENTS CONTAINED HEREIN, TOGETHER
WITH ALL EXHIBITS AND ATTACHMENTS ARE TRUE, CORRECT AND COMPLETE AND THAT I/WE HAVE AUTHORITY TO SIGN THIS
DOCUMENT. SIGNATURE(S)
__________________________________________________________ Maricopa County ____________________________________________________
(Name of Corporation, Partnership, etc.) Date Signature of Applicant (Individual) Date
__________________________________________________________ _____________________________________________________
Signature Title Signature of Applicant (Individual) Date
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Maricopa County
5N 3E 12 & 13 74.71
see attached page
Maricopa County October 26,1993
1.5 DU/ACRE RE-35
Waste Transfer Station and closed landfill
N/A N/A
No change to use
APS APS
X X

FORM (RW-R)
ROADWAY
SUPPLEMENTAL INFORMATION REQUEST
APPLICANT APPLICATION NUMBER:
NAME: Maricopa County
1. ROADWAY IMPROVEMENTS
EXISTING ROAD 40 feet PROPOSED ROAD
EASEMENT WIDTH: EASEMENT WIDTH: 40 feet
EXISTING ROAD ___ X Pavement ____ 28 ft. PROPOSED ROAD ___ X Pavement ____ 28 ft.
SURFACE (please mark ___ Gravel ____ ft. SURFACE (please mark ___ Gravel ____ ft.
appropriate item & ___ Dirt ____ ft. appropriate item & total ___ Dirt ____ ft.
width) ___ Other: ____ ft. width of existing & ___ Other: ____ ft.
____________________ proposed) ______________________
____________________ ______________________
OTHER EXISTING ___ Curb OTHER PROPOSED ___ Curb
IMPROVEMENTS: ___ Gutter IMPROVEMENTS: ___ Gutter
(please mark appropriate ___ Median (please mark appropriate ___ Median
items) ___ Sidewalks items) ___ Sidewalks
___ Street Lights ___ Street Lights
___ Turn Lanes ___ Turn Lanes
___ Trails ___ Trails
___ X Other: ___ Other:
____________________ existing gate ______________________
____________________ ______________________
2. FUNDING
HOW WILL ___ Private Developer ADDITIONAL ___ Impact Fees/Credits
PROPOSED ___ City Funds FUNDING ___ Development Agr.
ACQUISITION & ___ X County Funds CONSIDERATIONS: ___ Payback Agr.
CONSTRUCTION BE ___ State Funds (please mark appropriate ___ Grant/Bond
FUNDED? ___ Federal Funds items & provide copies) ___ Other:
(please mark appropriate ___ Other: ______________________
items) ____________________ ______________________
____________________
3. MAINTENANCE & OPERATION
WHO WILL MAINTAIN WILL THE EASEMENT ___ Yes, to:
& OPERATE THE Maricopa County BE ASSIGNED? ______________________
ROADWAY? ______________________
___ X No
4. ACCESS TO STATE TRUST LANDS
ARE THERE IF YES, WILL
ADJACENT STATE ___ Yes APPLICANT DEDICATE ___ Yes
TRUST LANDS THAT ___ X No PUBLIC EASEMENTS OR ___ X No
ARE LANDLOCKED? PROVIDE STATE TRUST
WITH ACCESS?

ARIZONA STATE LAND DEPARTMENT
REAL ESTATE DIVISION
ADDENDUM TO APPLICATION
REQUIRED PRELIMINARY APPLICATION INFORMATION
This completed form, signed and dated by the Real Estate Division, must accompany every
New Right of Way or Right of Entry Application. The Department will not accept an
application for a right of way or a right of entry without this form being completed.
APPLICANT INFORMATION
Applicant Name: ____________________________________________________________ Maricopa County
Contact Name: ____________________________________________________________ Dennis Lindsey
Mailing Address: ____________________________________________________________ 301 W. Jefferson Street, Suite 960
City: _________________________ Phoenix
State & Zip Code: _________________________ AZ 85003
Phone: _________________________ (602) 506-1067 Fax: _________________________
E-Mail: ____________________________________________________________ dennis.lindsey@mail.maricopa.gov
PARCEL INFORMATION
Section/Township/Range: ____________________________________________________ 7 / T5N / R4E
Political Jurisdiction: ____________________________________________________ Maricopa County
Existing Zoning: _________________________ Rural-43
General Plan Designation: _________________________ open space
Existing Adjacent Land Uses: ____________________________________________________ Radio Towers
North: ____________________________________________________ Vacant
Golf Course
East: ____________________________________________________
South: ____________________________________________________ Closed Lanfill
West: ____________________________________________________ Radio Towers
Proposed Project Description, purpose and/or need for the requested right of way?
_____________________________________________________________________________ Existing road previously granted by BLM for access to solid waste landfill.
_____________________________________________________________________________ Road will provide legal access to the solid waste transfer station located
on a portion of the closed landfill.
_____________________________________________________________________________
- 2 –
1/2010 ROW Application Addendum

What is your opinion of the value of the right-of-way you wish to acquire the rights to, per acre,
and if appropriate, per square foot?
_____________________________________________________________________________ TBD
_____________________________________________________________________________
_____________________________________________________________________________
What are the funding mechanisms that will assist and or pay for this right of way? Are there
constraints, stipulations or deadlines with the funding?
_____________________________________________________________________________ No funding constraints
_____________________________________________________________________________
_____________________________________________________________________________
Is access an improved dedicated public street? ‘ Yes ‘ X No
Describe access and identify road names: ____________________________________________ Cave Creek Solid Waste Transfer Station
______________________________________________________________________________
Are there any drainage and/or flood plain constraints or requirements for the use or proposed
project? If yes, what are the proposed plans to address them and how or will they impact the
proposed use?
_____________________________________________________________________________ None
_____________________________________________________________________________
_____________________________________________________________________________
Are there any waterways/washes in along or within the project area? If yes, what are the sizes
and what constraints and/or issues may they generate?
_____________________________________________________________________________ None
_____________________________________________________________________________
_____________________________________________________________________________
Has the proposed use or proposed project been presented and/or vetted through the local, State
or Federal jurisdiction? If yes, what was the jurisdiction’s position? Please include any letter
of support and/or stipulations imposed on the project.
_____________________________________________________________________________ Existing access road
_____________________________________________________________________________
_____________________________________________________________________________
- 3 –
1/2010 ROW Application Addendum

Are there any pending projects associated with this use or proposed project? If yes, do they
require other rights of ways or acquisitions to complete the project? Please explain.
_____________________________________________________________________________ Existing radio towers west of road. The access road will be used to access
_____________________________________________________________________________ solid waste transfer station and radio towers
_____________________________________________________________________________
Are there any extraordinary issues affecting the use or proposed project that you are aware of,
such as the existence of endangered species, cultural resources, topographic constraints, etc.?
_____________________________________________________________________________ None
_____________________________________________________________________________
_____________________________________________________________________________
What, local, State or Federal approvals, if any, are necessary for this use or proposed project? If
a Certificate of Environmental Compatibility (CEC) by the Arizona Corporation Commission is
required, when are you planning to file the application? If filed, please provide a copy of the
application.
_____________________________________________________________________________ None
_____________________________________________________________________________
_____________________________________________________________________________
Why are you requesting that this parcel be encumbered with a right of way at this time? Please
provide supporting data.
_____________________________________________________________________________ Right of way previously granted by BLM has expired
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
For Real Estate Division Use Only
Preliminary Application Conference Took Place with: _________________________________
Real Estate Division Signature: ___________________________________ ______________
(Date)
- 4 –
1/2010 ROW Application Addendum

ARIZONA STATE LAND DEPARTMENT ENVIRONMENTAL DISCLOSURE QUESTIONNAIRE
These two pages are part of the application - DO NOT DETACH.
The purpose of this questionnaire is to give the Department an opportunity to detect proposed land uses that may have potential environmental impacts and risks, and to
consider these impacts and risks in the processing of the application.
If you have questions regarding this questionnaire, please contact the State Land Department, Environmental Section at (602) 542-2119. Other Federal, State, County
and local agencies may also need to be contacted regarding environmental regulations.
PLEASE INDICATE BELOW THE TYPE(S) OF POTENTIAL ENVIRONMENTAL IMPACTS FROM YOUR CURRENT OR PROPOSED USE:
YES NO WILL YOUR USE INVOLVE: TYPE OF ENVIRONMENTAL IMPACT
X
WASTE TIRES The collection of waste tires? If yes, explain:
X
LEAD ACID BATTERIES The sale and disposal of lead acid batteries? If yes, explain:
X
DISCHARGE IMPACTING GROUNDWATER Generating a discharge that may potentially impact groundwater? If yes, explain:
X
PESTICIDES? If yes, explain use:
X
DRY WELLS? If yes, ADEQ Registration #(s):
X
POTABLE WATER (DRINKING WATER) SYSTEMS? If yes, explain:
X
WASTEWATER COLLECTION AND TREATMENT SYSTEMS Wastewater collection and/or treatment? If yes, explain:
X
AIR CONTAMINANTS/AIR POLLUTION CONTROL Air contaminant emissions? If yes, explain:
X
SOLID WASTE - GENERAL Solid waste generation, transportation, treatment, recycling, storage or disposal? If yes, explain:
Existing road is used for transporting waste to the solid waste transfer station
X
SOLID WASTE - MEDICAL WASTE Medical waste generation, transportation, treatment, recycling, storage or disposal? If yes, explain:
X SOLID WASTE - SEWAGE SLUDGE/SEPTAGE (Septic Tank Waste) Sewage sludge/septage generation, transportation, treatment, storage, use
or disposal? If yes, explain:
X
USED OIL Used oil generation, transportation, storage, recycling, use, disposal, marketing or burning? If yes, explain:
X
RECYCLING ACTIVITIES? If yes, explain:
X
SPECIAL WASTE Special waste (asbestos, motor vehicle shredding waste) generation, transportation, treatment, recycling, storage or disposal?
If yes, explain:
X HAZARDOUS WASTE GENERATOR Generating hazardous waste? If yes, explain:
X
HAZARDOUS WASTE TREATMENT, STORAGE, OR DISPOSAL? If yes, explain:
(OVER)

YES NO WILL YOUR USE INVOLVE: TYPE OF ENVIRONMENTAL IMPACT
X
HAZARDOUS WASTE TRANSPORTATION? If yes, explain:
X
UNDERGROUND STORAGE TANK (UST)? If yes, explain:
X
ABOVEGROUND STORAGE TANK (AST)? If yes, explain:
X
HAZARDOUS SUBSTANCES? If yes, explain:
X
CURRENTLY UNCLASSIFIED WASTE Will your use involve currently unclassified waste containing the following? (A.R.S. §49-854). If yes,
check appropriate waste category:
___ Polychlorinated biphenyls (PCBs) ___ Oil and gas exploration drilling muds ___ Petroleum contaminated soil
___ Incinerator ash ___ Categorical industrial pretreatment sludge ___ Commercial/industrial septage
___ Petroleum refining waste ___ Radioactive waste ___ Used Antifreeze
___ Slag and refractory material ___ Uranium ore tailings ___ Contaminated process equipment
___ Precious metals recycling ___ Industrial catalysts ___ Industrial Sludges
___ Aluminum dross ___ Industrial sands (excluding mining or mineral processing operation)
If checked, explain waste generation process:
X SUPERFUND SITES Is the State Trust land located in a National Priority List (NPL, Federal Superfund) area or in a Water Quality Assurance
Revolving Fund (WQARF, State Superfund) study area?
If yes, NPor WQARF area name:
X
LAND DISTURBANCE If land disturbance will occur, will it be on previously undisturbed land? If yes, explain:
X
WATER WELLS Are there open and/or abandoned water wells on the property? If yes, submit a site diagram showing location(s) and use(s).
X ADJACENT LAND USES To the best of your knowledge, are adjacent lands subject to any of the above-referenced environmental impacts? If yes,
Road will provide legal access to solid waste transfer station
explain:
x
ON-SITE INSPECTION/ENVIRONMENTAL ASSESSMENT To the best of your knowledge, has an on-site inspection and/or an environmental
site assessment been performed at this location?
If yes, explain:
X
PREVIOUS ENVIRONMENTAL IMPACT To the best of your knowledge, has any environmental impact been reported previously to ADEQ?
If yes, explain:
ADDITIONAL COMMENTS:
Environmental Questionnaire Revised 12/09