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F o R M <br />COLORADO DIVISION OF WATER RESOURCES <br />For office Use oNy <br />M4 <br />" <br />DEPARTMENT OF NATURAL RESOURCES <br />�° <br />122195 <br />1313 Sherman St., Rm 818, Denver, Colorado 80208 <br />! <br />Phorie: (303) 866 -3587 <br />GCO [ p 45 <br />3s `Z m °Z rt55" <br />d� da s9 ✓ S7A`iE EraGlt� wy f <br />sc.] • - ✓ <br />REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORMC <br />GRAVEL PIT WELL PERMIT APPLICATION <br />1. <br />P F PERMIT <br />El NEW PIT(S) <br />ti , Cn <br />® PIT(S) EXIST, CONSTRUCTED AFTER DEC. 31, 1980 <br />! ' <br />2: <br />APPLICANT INFORMAJION <br />NAME(S)Western Mobile Inc., a subsididry of Lafarge Corp. <br />Mailing Address 1590 West 12th Avenue <br />.low s <br />o �.cui u <br />City, St. Zip Denver, CO 80204 -3410 <br />Phone( 303 ) 657 -4331 <br />3. <br />CONSULTANT/ATTORNEY /OPERATOR CONTACT Cf (if different than #2) <br />NAMES) Tuttle Applegate. Inc. <br />PIT NAME 35th Avenue Pit <br />Mailing Address 11990 Grant Street, Suite 304 <br />City, St. Zip Denver, CO 80233 <br />DMG NO. M-77 -036 <br />Phone ( 303 -y452 -6611 <br />4. <br />FERAL LOCATION OF COUNTY Weld <br />114 114, Sec. 34,35 Twp. 6 ® N. ❑ S., Range 66 ❑ E. ® W. 6th P.M. <br />5. <br />Estimated maximum water surface to be exposed: _2T J Acres. Number of Pits 2 <br />6. <br />Estimated. depth of pit(s)__4L5. 0 Ft. Estimated depth to groundwater 5.0 Ft. <br />7. <br />Estimated date to expose groundwater currently exposed ; to complete mining 2020 <br />8. <br />ATTACHMENTS: (Check which have been attached.) <br />(a) ® Scaled map of pit area with range, township, & section dearly indentifed (REQUIRED). <br />(b) ❑ Copy of the reclamation permit, if applicable. <br />(c) ❑ Copy of pre 1 /15189 water conservancy dist. or water user assoc. augmentation agreement, if applicable <br />0 <br />(d) Copy of proposed substitute water plan or augmentation plan application, if applicable. <br />❑ <br />(e)' Copy of court approved augmentation plan, if applicable. Case No. <br />❑ <br />(f) Other <br />S. <br />Detailed description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amour <br />of diversion of any water withdrawn from the pond. <br />Dust control - 2.0 acre-feet; moisture in mined material acre -feet: <br />r� <br />0 <br />1 (we) have read the statements made herein and know the contents thereof, and that they are true to my (our) <br />knowledge. [Pursuant to Section 24 -4 -104 (13)(a) C.R.S., the making of false statements herein constitutes pedu <br />in the second degree and is punishable as a class 1 misdemeanor.] <br />N VeMitle (Please type or prin) <br />t fit, &oc7Y�`noe!%r <br />Si atu <br />Date <br />Se <br />For Office Use oNy <br />) <br />Court Case No Div. Co. WD Basin MD Use <br />