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COLORADO DIVISION OF WATER RESOURCES <br />DEPARTMENT OF NATURAL. RESOURCES <br />1313 SIiERMAN ST., RM. 818, DENVER CO 80203 <br />phone -info: (3031 866-3587 main: 1303) 866-3581 <br />MONITORING/OBSERVATION Water Wetl Permit Application <br />Review itatnlctions m form. Must be clad u1 Wedc .dc or ed <br />1. APPLICANT INFORMATION 6. USE OF WELL <br />rrs.a.rsk+s <br />~/ ~- <br />Ho%ra..n, lac. ~ GROUND WATH( SAMPLING (quality) <br />MONITOR WATER LEVELS <br />~ OTHEA• <br />0"'Wp A°r0^ 7. WELL DATA +~' Sce aL rc~tyeL cow+Sl'. i <br />3 500 5'1"~-~ {~ i~ ~w...r / 2.o T^d ~ ~- <br />~F7 feet Codell 54.rda•FeNe <br />qw °0100 apao0i 8. CONSULTANT WFORMATION (o 'txlall <br />~loreace Co $/2Z6 t~~. <br />p/, <br />r.w.0....m.ar0a0...mw ~ <br />ICoN~t~ ~ Tt.cr..ler ~.G, K-5 ~ Co. <br />~~~9~ 78'f- I2o9 "°°"" iSZZ.o ~ C/over ue <br />2. TYPE OF APPLICATN)N (check a 'cable bmt(es)) Mo NwOn e.u-I- CD 90(3 Z <br />Use adstinp weU O Replacemartt for - <br />O Construct new weU permh no. rr.rlea.n.ro. o.srr.t...osar <br />X7/9 .{Lbo - ,59,5 Z_ <br />O Other. 9. PROPOSED WELL DRILLER ( onall <br />3. REFER TO fd a cable): cq"°'" """ 11001gO nin°` <br />YwYOw:y M1. WrnmoiQrmnrc i w.a,e.me ar ~ <br />MH- 35S13Z /vi W - 7 10. SIGNATURE of ap licantts) ~ authorized a ant <br />4. LACATION OF WELL The making of false statenreras herein oonstibites petjuy <br />tway y, <br />t- Y¢1MOwf 1 onvar/quursr <br />5 E yi otorsrr <br />SE 34 in the secant degree, whk:h is pts1is11sble aS a lose 7 nlis- <br />tlerrlearlor Pmt m C.RS. 244104(13)(a). 1 have read <br />6ao0ion <br />1 '7 ~Tawtatq N a S <br />19 O Ril RWa E or W <br />!0 8 O PINrW Ns7sn <br />(o K the Sta'IMnerdS herein, krW W 111E COrItdILS thereof, and SWOE <br />that may are true m my knowiedae.. <br />Dlstam» of wsa ttwrt roetlon ao~s <br />80o m tram O N S 75o ti. Lam E ~ w ru.t M~(N.I.Ipo1~ . <br />~ <br />/,,,~,Q~ <br />vw bw1...Wrw tl am.atntn wkrs.+ew M teorertY K <br />• <br /> <br />fr<.ybe.n.e.. W ... • B.a.e..,..~.wbn b.n aW ..+a a.M,M.. <br />feet direction T10e L ei0' <br />5. OWNERSHIP WFORMATION Cow73.a./fawl 5-9-«a <br />wru. owoe wurf N Ma..s a.In.MSwna Seethe reverse side of tNs form fa irlsurmiorle, fee, and <br />iMomudon <br />"'°'~ OP'TIONAL INFORMATION <br /> YiaGmtoarar ownaitn..w swrew.r. <br />car atd. rt, cae. <br /> Office Use ONy <br />TNrarr%praW waaatl <br />DIV <br />ilrOPfiIIY Orr181IMYE a mNmc tlan sbwd <br />CO <br />AMar <br />WD <br />qty &to byf:aae <br />TYyMwm. idW~twleosy <br />USE MD <br />Form GWS-46 (12/95) <br />