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T COLORADO DIVISION OF WATER RESOURCES s•«Ct+k:rrr u~~C„y <br />DEPARTMENT OF NATURAL RESOURCES _ <br />tJt3 S'rermonSt. Rm a'8 Dcrver Coiorsdo 8020) ~rV~ ~iK D, <br />Pnone i303)869~3SA' - _ apG, 14~ Z[~ <br />REVIEW LVSTRUCTiCNS PRIOR TO COMPLETING FORM ++CM v^t'!~'r <br />JEL WELL PERMIT APPLICATION I ~rr~ <br />~M.... 1M <br />U NEW PIT(S) <br />PIT(S) EXIST. CONSTRUCTED AFTER DEC. 3t 19°0 <br />NAME(Sl Mott F'clinv <br />Me~'mg Address P i) _Rut SiW9 <br />City, St .Zip Ruc:J \'isty C0 81211 <br />Phone t 11~ ~ 79<-~(Nl --- <br />COUNTY <br />E LX.1 W. Sl.ith P M <br />$ <br />IIItlG11CU ! <br />township, 6 section clearly identified (REQUIRED) <br />pphcable <br />ancy dlst Or water user asatx augmentation agroement. if apphcabse <br />plan or augmentation plan application, A appocable <br />on peen, d apphcab•'e Case No. <br />WJrpr lp,~! in n!U![Nd! <br />1'i1 ,iNlP rrqura'r. ruhmitteJ <br />n <br />i ` L, <br />Court Case No _ Div a' Co LYD_Il .__ Bann MD _ . Use. <br />QENflING Siu7Q R~4ru~T' <br />Rl:c'p. II(~~zcu~.. ~ <br />gE 55+st' ouc TO <br />QftlvhS~ Cowwt_T~T' <br />~O('Z ~'V t EYU GtUEO <br />11,J 1A,°FILTCGI.S A.3 <br />M spy .! <br />PIT NAMlEV ~ Jeue Lee Pit <br />DMG No. N-$r~ou <br />