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......... ..... ..wr......w <br />DEPARTMENT OF NATURAL RESOURCES <br />~31a sNERMAN sT., R11578, oervEx. CO tllYlOt <br />-~: (sosl ees-ssa~ xx~m: (so3~ ees-3sa, <br />rax sos eee-ssea ~ ~r«~xw.wemr.saeeco.~s vne.o a,ae v,er FOm1 GYVS-~8 (12001) <br />MONITORINGIOBSERVATION <br />Water Well Permit Application <br />. ~ xlvmae side rylor to eempktlng fo11n <br />nx: f019~ nwst be ax9pleted ~ bpdc int ' <br />1. We0 Owner irtfonrtation 6. Use OF Well <br />x.nea.w e.nw <br />Ho%~.,n Z~ ~, Use Of this well is OmiEed 1^A monitoriflg wafer levels <br />attdrer waffir gt,alur eatnpling <br />~ <br />~ <br />' 7. Well Data (pntposean <br />l 11 1 // <br />3500 STS7-G I7 r' I1.0 d I z 0 TW UepeA Mder <br />Ga aswee ~/8 feet Code ~ ~ .SS <br />Ff o re,~c.e, co 8 /zz ~ e. ca~lafn liffortna>fort (il app6cab~> <br />Tdeplwnes <br />( ~/9 ~ ~85~-(w32.5 Neewaawsnywem <br />pr.,a.ld ~. -rLLr,~er ~.G. <br />2 Type OI Application (clwdt appficaMe boxes) cmo.n ~. <br />~tlse e~thlg weu ^ Reylece11xx6 for e>val¢g nxsdorig wed - 5 ~ Co n~ °.." =i.1 c . <br />^ Construct new aee <br />^ l)e1er. Pe11n(t m.: xer~9.a1x.. <br />! 82ZO ~i~ c-foyer ~°-~+ e <br />3. Rsfer To (1f applica ble) suf. ao aaa <br />w <br />ewrwYO ~e.aeio.ledpewo wr eameers L <br />W)oN.,...., ew.1-` Co 8or3z <br />~- 379/ itnw ~ 8 raswes <br />4. Locaflon OI YYell (7/9) /Floo -5 r.S2 <br />~xa 9. MIMI Dr01sr license <br />~r~..~ e...-~ N E w elsw 5 E w 70. $iQrlaUse OF Well Owner, ConsUllant Or Autlwrixsd <br />smmm roeewup xars xe.p Eerw errrpr,ewics. <br />!~ 19 ^ ~ (o g ~ (fl ~ Tt1e meKrtq dtefee stalallags txsetrl peljlsy ~ 0re aemlq <br />degl9e, v11Yd1 is plsYst1s61e es a doss 1 ni6da11~11or Pv b C.R3. <br />oimexawelewe serlmim fa+m~reaaebAdr~pmsntiN 24.4-704(73x8)_ Ihare rea0 the sthereh~. lsa~w tl~e oo~ts <br />tilBleof 811d SfefBfist 819 ifUe tO <br />22a~o Ran^N~S 550 rtsue~E^W eaews eeorlx/eY}~ea) om <br />FveyYOmrewebmy-drJwea aol6aCNn hoe etlwe~b newts v~ <br />7' ~-O/ <br />iBel 1 19ie 6eb <br />w.loeNOe.dio a+OVF.e1e) <br />Koa,d.~ ~. ~.~r~er ~.G. L'susti~Ta... <br /> U <br />~ <br />OptlaW: GPS e,M bmGon itomreon in llTS1 fanut Se <br />~ <br />~ <br />Reputed eelfiesiorGP3 udsae asfoYws: 11589 oe0 owoe ONft®pna swroeela <br />ram,eooseeulr <br />ma wreet5 Nye Reoe~t area oldy <br />Ubeeetbelelwe <br />W eee wmt ee IU15Q71n0018) <br />UIY.oelee6elbeeelvN <br />wels <br />Ptll <br />baYO <br />nC~ ^ ~'E$ ^ Ix) <br />69 <br />p <br />~ <br />~ <br />~ <br />5...v~.y ~itnaden <br />xeoeWyiepoyelwO <br />Hol~1a,.~ z~~, <br />~~ <br />35~ 5~-~ <br />-t-e F(~ ~ <br />1~ <br />- <br />...~4 <br />~ sm ~ <br />Floreti~ e Co S/ZZ6 <br />Telopxroi <br />