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POLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-45(0712013) <br /> DEPARTMENT OF NATURAL RESOURCES <br /> 1313 SHERMAN ST,RM 821,DENVER,CO 80203 <br /> Main: 303 866-3581 Fax: 303 866-2223 dwr ermltsoniin 'a�state co us <br /> GENERAL PURPOSE <br /> Water Well Permit Application <br /> Review instructions on reverse side prior to completing form. <br /> The form must be computer generated,typed or in black or blue ink. <br /> N1.a Applicant Information <br /> Name ii applioxrtt 6. Use Of Well (check applicable boxes) <br /> _ <br /> Attach a detailed description of uses applied for <br /> AuPt Industries LLC ❑ industrial ❑ Dewatenng System <br /> M�Nng address PO Box 1424 ❑ Municipal ❑ Geothermal(production or reinjection <br /> City State Zip code ❑ Irrigationmer Other(describe) Placer Mining <br /> Edwards CO 81632 ❑ Commercial <br /> Ttrtapnoiie a urea code&number) E-mail}online riling required) 7.Well Data(proposed) <br /> 970 306 1784 peter@auptindustries.com Mamrr.m pumping rate Annual amount to be withdrawn <br /> 2.Type Of Application (check applicable boxes) 200 gpm 25 acre-feet <br /> ®Construct new well ❑ Use existing well TNa,depth Aquifer <br /> ❑Replace existing well ❑ Change or increase use 76 feet Wasatch Formation <br /> ❑Change source(aquifer) ❑ Reapplication(expired permit) 8_ Land On Which Ground Water Will Be Used <br /> ❑COGCC Well 0 Other: Legal Description of Land,,may re prowaed as an attachment. <br /> 3.Refer To(if applicable) <br /> well perrrrni# Water Court case# E 1/2 Sec. 24, T. 12N., R. 92 W., 6th PM <br /> Destgrteied Bas n Determination# Wen name or# Moffat County, Colorado <br /> 4. Location Of Proposed Well <br /> bounty (If used for crop irrigation,attach a scaled map that shows irrigated area <br /> Moffat NE 114 of the NW 1/4 A #Acres B. Owner <br /> Section Township N or S Range E or W Primpal Mendran <br /> 24 12 X 94 ❑ IK 6th PM C l ist any other wells cr water rights used on mis nand <br /> Dosiance of well from section lines(secton lines are typcwiy not property Lnes) <br /> 1000 Ft from Ix N S 1600 Ft trcmrE OW For replacement wails only-distance and direct on from old well to new we!, 9. Proposed Well Driller License#o tional : <br /> feet direction 10.Sign or Entered Name Of Appllcant(s)or Authorized Agent <br /> Well location address tincuda Gty State.Zip ❑Check if well address s saris as in item 1 The making of false statements herein constitutes perjury in the second <br /> degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S. <br /> E 1/2 Sec. 24, T. 12N., R. 92 W., 6th PM 244-104(13)(a). I have read the statements herein,know the contents <br /> reof a state that they are true to my knowledge. <br /> Optional: GPS well location information inUTM format You must check GAS unit for S gn ante n (s)of sons)submming appnra on Date(mrn/ddryyyy) <br /> required settings as follows _ 2 / 6 <br /> Format must be UTM R sigA g na. and btl ''t <br /> "`Zone 12 or!_)Zone 13 Easting <br /> Units must be Meters �C �E ©Y✓1 b�r _ <br /> Datum must beNADa3 Northing Office Use Only <br /> Unit must be set to"a norm <br /> Was GPS unit checked for ❑ Remember to set Datum to NA083 above YES USGS map name DWR map no Surface elev <br /> 6.Parcel On Which Well Will Be Located <br /> _,__(PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) Receipt area only <br /> A Legal Description(may be pro%nded as an attachment, <br /> See attachment <br /> B. #of acres in parcel C. Owner AQUAMAP <br /> 80 St. Board of Land CommissionEM WE <br /> WR <br /> D. Will this be the only well on this parcels YES In NO(d no list other wells; <br /> CwCO <br /> TOPO <br /> E. State Parcel to#(optional) MYtAR <br /> S85 DIV WD BA_ MD _ <br />