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Fonn No. COLORADO DNISION OF WATER RESOURCES For ofRCe Use onty <br />GWS•27 DEPARTMENT OF NATURAL RESOURCES <br />312003 7313 Shannon St, Rm 818. Denver, Colorado 80203 RECEIVED <br /> Phone: (303)888-3581 <br />REVIEW INSTRUCTIONS PRlORTO COMPLETING FORM <br />GRAVEL PIT WELL PERMIT APPLICATION JUN 0 2 2003 <br />1. TYPE OF PERMIT <br /> <br />N <br />EW PIT(S) WATER RESOURCES <br />STATE ENGINEER <br />coio. <br /> _ <br />((~~'~ _ <br />k~PIT(S) EXIST, CONSTRUCTED AFTER DEG. 31,1980 <br />2• APPLICANT INFORMATION <br /> NAME(S) J/arra Companies, inc. <br /> <br /> Mailing Address 8120 Gage <br /> City, St. Tap Feederick CO 80516 <br /> <br /> Phone( 303 } 666-6657 <br />3. CONSULTANT/ATTORNEYIOPERATORcONTACT (IF dot than #2) <br /> NAME(S) Cheryl Signs PIT NAME <br /> <br /> hAaNngAddress 109 ~ 4th Ave <br />CI'ty,St.Tap Denver CO 80203 <br />DMGNO. <br /> <br /> Phone( 3n3 } 778-7653 <br />4. GENERAL LOCATION OF Prr(S): COUNTY Weld <br /> 114 t/4, Sec.3 , 9 , l Ofwp. 5 ©N. ^ S., Range 6 5 ^ E, 0 W. 6th P.M. <br />5. Estimated maximum water surface to he exposed: t S 7 Acres. Number of Pits 4 <br />B. Estimated depth of pit(s) 5 0 Ft Estimated depth to groundwater 8 -10 Ft. <br />7. Estimated date to expose groundwater exi s t i nq ; to complete mining 2 0 2 <br />8. MENTS: (Check urtlkh Flave bean aCeohed.) <br /> (a) Scaled map of ph area with range, townshQ, & sectlon dearly identdled (REQUIRED). <br />(b) ^ Copy of the reclamation permit. "d app8cable. <br />(c) ^ Copy of pre 1!15!89 water conservancy diet a water user assoc. augmentation agreement 'd applicable. <br />(d) ©Copy of proposed substitute water plan or augmentation plan applicatlon, if applicable. <br />(e) ^ Copy of court approved augmentation plan, if applicable. Case No. <br />(f) ^ Other <br />9. Detailed des<xptlon of arty use, other then evaporation, and method of diversion, rate of dhrersion, and annual amount of <br /> diversion of any water withdraRm iron the pant. <br />production use, pump, 0.72 MoD, 15 acre-feet <br /> dewateryng, pump, 0.72 MGD <br /> <br /> <br />10. 1(we) have read the statemerts made herein and know the cOrrlents thereof, and that they are true to my (our) <br /> knowledge. [Pursuant to Section 24~-104 (13xa) C.RS., the making of false statements herein consOtutas perjury <br /> in the second degree and is punishable es a 1 misdemeanor.] <br />Name/Ttfle (Please type or pdr>U <br />Chris Varra~fPresident 51 Date , <br />May 31, 2003 <br />Fa~~OAN voice 8 511882 <br />6/2/2883 -- 14:83:53 <br />Cashier ID: 3 <br />(448.88 <br />Court Case No. Div. _ Ce. _ WD _ Basin ` MD _ Use Check Purchase- Y3488 <br />