My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2014-05-12_PERMIT FILE - C2010089 (8)
DRMS
>
Day Forward
>
Permit File
>
Coal
>
C2010089
>
2014-05-12_PERMIT FILE - C2010089 (8)
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/8/2017 10:11:18 AM
Creation date
8/8/2017 10:09:17 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C2010089
IBM Index Class Name
Permit File
Doc Date
5/12/2014
Doc Name
Approved Well Permits
Section_Exhibit Name
Appendix 2.05.6(3)-4
Media Type
D
Archive
No
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
61
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
COLORADO DIVISION OF WATER RESOURCES <br />Office Use Only Form GWS-46 (07/2009) <br />DEPARTMEIIT OF NATURAL RESOURCES <br />( _ <br />1313 SHERMAN ST., RM 818, DENVER CO 80203 <br />phone - Info: (303) 866 -3587 main: (303) 866 -3581 <br />Fax: 03 888 -3589 http:/AwW.vMer.sIate.co.us <br />APR i 2011 <br />MONITORING /OBSERVATION <br />Water Well Permit Application <br />WATER REST <br />Review Instnulions an reverse side prior to completing form. <br />STATE EIVgINtEFr- <br />(XV „ <br />The form must be completed in black or blue Ink or typed. <br />1. Well Owner Information <br />S. Use Of Well <br />Use of this well Is limited to monitoring water levels — <br />Name orVMI MW ' - -� <br />WeSr /n Fuels <br />— — <br />andlior water quality sampling <br />7. Well Da_ ta (proposed) <br />0alfrmadkkess <br />Po * s z <br />_ - - -- <br />Tath &Pth <br />'041(0t4 <br />114 te st <br />stae Zip code <br />Q g f q.9. 1/ <br />� <br />8. Consultant Information (if <br />applicable) <br />Tdephons M _ 1 E-Mail (Oprand) — <br />Name of contact person <br />(970) 96 If - .2165 <br />/�,'� Lv"de _ ___.._------ __ -� -- <br />Wefyrn FdBls AS%ocidti7v- -- - <br />2. Type Of Application (check applicable boxes) <br />- <br />❑ Use eAsting well ❑ Replaosment for existing monitoring well: <br />® Construct new well Permit no.: <br />❑ Outer: <br />Mlliing sd&ess <br />t? 9 3 _ <br />. __�0 3 _X.._._ -2 _ <br />3. Refer To (if applicable) <br />ary State Zip Code <br />WaNtorkp hole egmowledWrent <br />Wel Hans or 0 <br />MH- <br />G W -N6-? <br />Telephone r <br />(3 °t ) 30 <br />4. Location Of Proposed Well (Important! See Instructions ) <br />Cc" —` "r'- - -- <br />11/ ,1401u,e IYW 1/4 <br />9. Proposed Well Driller License o tional : <br />10. Signature Of Well Owner Or Authorized Agent <br />Seduon — �ownship N s a.nge -- E «W pnndp>< btedaan ""- <br />The making of false statements herein constitutes in the second <br />or <br />I <br />C9 11 & ❑ 12 <br />perjury <br />degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S. <br />q-7 <br />"LLL,�� W <br />244-104 (13)(a). f have read the statements herein, know the contenls <br />.XILO <br />_- <br />of and state that they are true to_m knoviedge_ <br />Distance of wed nom saidon lines (section lines are l 1pkatip not preperky fines) <br />1 R 7Z Ft. frara ❑ N Q S (� 1 Ft morn ❑ E 29 W <br />Skin tine (MuM be oiryinN sigrmluej Oahe <br />Prot & title <br />For replacement watts ony _ deter ee and direction from old well to neW wen <br />r1R� e <br />feet direction <br />— <br />Wd bcallon edttiese (In010s pry, Stets. Zip)'V Check if well eddrsas T. same m kern 1. <br />fi <br />Office Use Only <br />2_(p D AA Rd Ndc 1y2 - _ <br />�_ —'1 ' <br />DVJR map no. <br />6urface dev. <br />Optional: GPs well location IMormation in UTrN formal <br />You must check GPS unit for required settings as folowsY <br />Falaat rn+et be UTM <br />—_ <br />Receipt area only <br />0 zone 12 or 0 zone 13 <br />Feting <br />NO At >H 7y <br />Units moat be Meters <br />Dahi m must be NADu <br />Northing <br />Unk not be sod to bue north <br />Well GPS unit dedmd for above? ❑ YES <br />; Remember to not Datum to NADBS <br />/ _ <br />Full', r', !'J;tR'rl i'r 31iQ (Jir$il �7 <br />4. I""'90 1 I 1 Jir -,,:; 111A <br />t- :.hh:itnrtiIu:i) <br />(•Dtut "thute.ILnt. $JUU.UU <br />5. Property Owner information <br />Nerreorproperivowner - -- - - - -- - -- <br />_i7reeq and (o• <br />(.,UI:I,'I+1,UI1hltltt: <br />WNW address <br />:f:7s�h:/ <br />Po o Box <br />Qtj State Zip Code <br />/Yuclo Ld gl�a <br />Div_ WD_ 8A_ MO _ <br />Telephones �- _— - <br />S � V9 A 9a —A /t O Z /•fin» /T/a.-V* c. 1 vOn <br />
The URL can be used to link to this page
Your browser does not support the video tag.