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R'' ~ <br />F o R tit COLORADO DIV N OF WATER RESOURCES I <br />Office Use only <br />no. <br />GWS-27 DEPARTMENT ATURAL RESOURCES <br /> <br /> <br />12/95 <br />1313 Sherman St., Rm e18, Denver, Colorado 80203 RECEIVED <br /> phone: 1303) 586-3681 <br />REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM ~; <br />1~~ ~ a ZOOI <br /> , <br />GRAVEL PIT WELL PERMIT APPLICATION Biyisiurl~l~nlnaralaaellceolo~ <br /> <br /> TYPE OF PERMIT <br /> ^ NEW PITISI _ <br /> 0 PITIS) EXIST, CONSTRUCTED AFTER DEC. 31, 1980 <br />2. APPLICANT INFORMATION <br /> NAME(S) Western Mobile, Inc. a subsidiary of Lafarge <br /> Mailing Address 1400 West 64th Avenue PO Box 215001 <br /> City, St. Zip Denver. CO 80221 <br /> Phonel 303 1 657-4425 <br /> <br />3. trQNSULTANT/ATTORNEY/OPERATOR CONTACT llf different than #2- <br /> NAME(S) Anole¢ate Group, [nc. PIT NAME Mann Lake <br /> <br /> Mailing Address 1499 W. 120t1t Avenue, Suite 200 <br /> City, St. Zip Denver. CO 80234-2728 DMG N0. M-82-147 <br /> <br /> Phdnel 303 1 452-6611 <br />4. GENERAL LOCATION OF PITISI: COUNTY Adams Countv <br /> 1 /4 1 /4, Sec.~~ Twp.~_ ^ N. 0 S., Range 67 ^ E. ®W. 6th P.M. <br />5. Estimated maximum water surface: to be exposed: 26 Acres. Number of Pits 4 <br />6. Estimated depth of pills) 20-25 Ft. Estimated depth to groundwater 5-10 Ft. <br />7. Estimated date to expose groundvrdter ; to complete mining 2006 <br />8. ATTACHMENTS: (Check which have been attached.) <br /> ^ <br /> lal R <br />Scaled map of pit area with range, township, & section clearly indentded (REQUIREDI• <br /> Ib- ^ Copy of the reclamation permit, it applicable. <br /> Ic) ^ Copy of pre 1 /15189 water conservancy dist. or water user assoc. augmentation agreement, if applicable <br /> ^ <br /> Copy of proposed substhrlte water plan or augmentation plan application, if applicable. <br />Idl <br /> lel ^ Copy of court approved augmentation plan, if applicable. Case No. <br /> ^ <br /> Other <br />lfl <br />9. Detailed description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amoun <br /> of diversion of any wafer withdrawn from the pond. <br /> 26.5 acre-feet R?r year retained in prndrrr; 3.0 acre-feet oar veer used for dust <br /> control. <br /> <br />0 I Iwel have read the statements made herein and know the contents thereof, and that they are true to my (ourl <br /> knowledge. [Pursuant to Section 24-4-104 11311a) C.R.S., the making of false statements herein constitutes perju <br /> in the second degree and is punishable as a class 1 misdemeanor.] <br />ame/Title IPlsaee type or printy~~ <br />~~~ ~ LV. ~~' J ignature ~ Date <br /> <br /> <br />v <br />For Offiee Uee only <br />Court Case No. Div. Co. _ WD Basin _ MD Use <br />