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S <br /> C" ✓ f` t� <br /> COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-46(11i20111 <br /> DEPARTMENT OF NATURAL RESOURCES -- <br /> 1313 SHERMAN ST.,Ste 821,DENVER CO 80203 <br /> Phone:(303)866-3581 dwr ermitsonlineAstate.co us <br /> MONITORING/OBSERVATION 1 '' <br /> Water Well Permit Application <br /> Review instructions on reverse side prior to completing form. <br /> The form must be typed,completed online or in black or blue ink. <br /> 1.Well Owner Information <br /> Name of well owner 6. Us_a Of Well <br /> Transit Mix Concrete Co. Use of this well is limited to monitoring water levels <br /> Melling address and/or water quality sampling <br /> 444 E. Costilla St. 7.Well Data (proposed) <br /> "oral depth Aqu ter <br /> C'ty State Zip,ane <br /> Colorado Springs CO 80903 <br /> 103 feet Granite <br /> Telephone# TE-Mail l If IN ing onfirie i s rNu-edo 8.Consultant Information (if applicable) <br /> (719)475-0700 Jerald.Schnabel@Transitmix.co Narry Lprtla='pens <br /> 2.Type Of Application (check applicable boxes) Comp Day <br /> Company nacre <br /> ❑Use existing well ❑Replacement for existing monitoring well <br /> E Construct new well Hydro-Logic Solutions, Inc. <br /> Permit no❑Other 56847-MH Md't'.9 icdress <br /> 3. Refer To(if applicable) 6100 Montview Blvd <br /> k+bnctoriN hole acknowledgmen! Well name a# C.tl. Slave Zip Cafe <br /> n1EI- 56847 LTC-GW-1 Denver CO 180207 <br /> 4. Location Of Proposed Well (important! See Instructions e1C°" # <br /> County (303)570-9527 <br /> El Paso NW 114 D,the NW ,.4 9. Proposed Well Driller License#(optional). <br /> Section Township I Nor S Range E o''A Principal Menysan 10. Name of Well Owner or Authorized Agent <br /> X x The making of false statements herein constitutes perjury in the second <br /> 16 16 1 67 6 degree.which is punishable as a class 1 misdemeanor pursuant to C.R.S <br /> 24-4-104(13)(a) I have read the statements herein,know the contents <br /> Distance of well trom semor lines i%ecton tares are tyvcally not property fires' thereof and state that they are true to my knowledge <br /> =t fro`r--- N~- S FI from E W Sign o'erier'A name here Dale(mr vdd,yy),r' <br /> Fw replacemenl wens only-distance and direction from old well t�new wel Jerald Schnabel 10/12/2017 <br /> feet direction 1'signing orini name Pint title if other than land owner <br /> Well location address(Include City State Zip) D Check if well address is same as lien,1 President, Transit Mix Concrete Co. <br /> 2485 Hitch Rack Ranch Rd. Colorado Springs, CO 80926 Office Use Only <br /> Optional. GPS well 1ccation information in UTM format <br /> You must check GPS Unit for required settings as follows USGS•rap na•ne DWR map no Surface elev <br /> Format mi sl lie L-TM <br /> Zone 12 or' Zone 13 Eashng 508355 Receipt area only <br /> Units must be Meters <br /> Datum must be NAD83 Northing 4279197 <br /> unit most be set to true north <br /> Remember to set Datum to NAD83 <br /> Was CPS unit cnectced for aboven a YES <br /> 5. Property Owner Information <br /> Name of property owner <br /> RMBC Group, LLC A <br /> Mailing address <br /> 712 Kris Ct. <br /> City State lop Code <br /> Los Alamos NM 187544 <br /> Telephone# <br /> Dill� WD �� BA_ MD __ <br />