Laserfiche WebLink
COLORADO DIVISION OF ihTAM RESOURCES Office Use Only Form GW8 46(07/2009) <br /> DEPARTMENT OF NATURAL RESOURCES <br /> 4313 SHERMA 9 ST.,RM 818,DENVER CO 80203 <br /> phone—Into:(803)0541167 maim PM)80s 3lt81 NOV ®� 2 D <br /> For 303 8R8.3t18i? htt Vvet�,a co. <br /> 11 <br /> MONITORINGIOBSERVATION VMTER kt <br /> STATE EPIi,, <br /> Water Wag Permit Application ,;� <br /> Roviewfnetrocgoits:on reverse side pdw to completing tam'. <br /> The form must be completed to Maok or blue tnk or typed. <br /> I.Well Owner.Information 6, a Of Well <br /> Ne"o1000Atar — _ _ _ __—_------------•---- -•------....----__. __ <br /> Use of this-well is Iln*ed to monitoring water levels <br /> and/or water quality sampling <br /> 7.WON data(proposecl) <br /> 1�..- <br /> S.Coasuitattt Information(11 applieable) <br /> ne a tvantaeremta�tpgteon 2.TMe Of Application c_ a appll)cahl®boxes) n++� <br /> - l aRA A use tNrtg well O ReplatxmeM forte anortkaktg web: ._ wF D <br /> -P ------ <br /> ©Construct dewwd Pem* <br /> 3.Refer o of e"ltcablej �- Ow Ste 21P OWS <br /> A.Location Of Proposed W#I1 I, rtatttl See Instructlottel <br /> do°t, � 1 .P Well Drillertonal <br /> �Lr'(` t I&SiSrla�ure Of Wall Owner Or Authorized Agent _ - <br /> a w The <br /> WWI is punstaterne �misdan�o p► want too C.R.S. <br /> 8yt4�»4 4b4(f3)(ei� I ad the a ebmentshareln,know the contents <br /> s'n "and state t am l4w!9 aw GIw e. <br /> astaxeot�hantreneontlbea(eeortm&ta°metypnexdrynrati ptopeAy Hhes) <br /> 1 r-t.vanPINOS L[sED FirtamiVEOw ` <br /> andtLe�anva¢divatenawwal ----- --- tbL— <br /> feet ddr00M <br /> IAhllheadonadRa4sHn4�+�e�lry.6late,apl Gte�9clfW�IWQreeshaemeaiilani. <br /> :••—.-•— <br /> You maeteltet: GPO W&W °ekMgsas b1b": <br /> t orMlIaMbeuru RecWarea only <br /> Eltans i2*r 0 Zone to c a a 7 a <br /> Ufftmmtbe mews <br /> pammust"Wr 1 .Nofflft 4 13 g 3$ <br /> tiro{mM beast to true north <br /> W8*WS uM dtaclm ft abM? ❑9Ee I tatbrnethW to sdt DOWM to NADU <br /> 6.Property Owner Information <br /> a"Otpa"W" <br /> me +o°a"" Transaction#: 3652885 <br /> ofit lL_.-11/1nO11 291:59 PM <br /> 0, ,,� -_ Transaction Toted: --i10o.00 — <br /> CRY swa 20co" CHECK <br /> `f1154 �$100.00 <br /> rYagttatea DNT MCI- 6A__,MD <br />