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Mar 27 03 04:48p Civil Resources LLC 3038332850 p.l <br />MAR-25-20D3 T~09: 32 ~ TETRL ~'ECN ,RMC FAX N0. 3036656959 P. 02 <br />'Vi'm : ~h1f~A ~f' ~t Z- ~~~~~~~~~~ ~,~ ~~~ <br />R~~. ~cxnhovd~' ~~~~ ~,, i.~a <br />600 FOOT WELL SPACINQ STATEMENT <br />t {wa),`TOwr. a~ )M,\1. fir.. ~~te a~o'llaws: <br />rµ <br />1. I (we) own real property Iopfed in tfte_,artd me_ of the,_ Bastian f , TownbMpYN, Range 67 W/ <br />_ ..,~°_' P.M., M?e~cr!County, Colorado. Located ot- our property are the following woN(s)~ <br />~.~,} ~ ylo~179 $&~ly, ~`++~ ~4__~,~. _~O_ a~ie...) ~ s~4tU , ~y,.~,, L.7w <br />uCaSr. ~c4r <br />x 1(we) ItBVe bean appraised Ihst ~N'~'`"" , the presotu owrtertol a parcel of kvW in ttw _ <br />and the ~ of the yE , 8ectie-r (~ Townbhip+~.N, RangeJ~,-,~° P.M., deffire to drill a new well(s) <br />(eceavatea grawrlplQ. t (we} aleourtda/standptet me purposeof suchwell(s)(gravalpit)istomirte <br />sand anp 8ravei and i (wo) havereviewed dte appl~ don(s) that were ~ubmitt~dlo the Otvislonoi <br />Mtnerei and Geology and with DAAta Numtrer(s) ~~ Y~ rapPtr+wd' <br />9. The proposed laration(s) 01 Mte wBA(a) (gravel pit) wiN De lebb than 600 feet hom are a more <br />at my law) well(s), <br />4. 13y this statemam I Iwo) am (are) ~+-ica11Y waiving any a~jecUan to the issuance of a wMl <br />permit(s) by the state Engineer to / for the subjod welds) (gravel Pa)• <br />5. ey signing tots statement - (we) am lace) riot waiving my {our) right w take necessary ao9on in <br />the lu[ure to protect my {our) WeU(s) from injury due to tl+e subject mirtirtg ope-atian. <br />hate this ~ day Ot +~Q___P1w.,_~ Z/~b <br />~ 7~ Er~inf~v- ~arr~ ~-~~m, u~ll ~ ~ <br />D <br />