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INSTRUCTIONS FOR THE COMPLETK)N OF GRAVEL PR WELL PERMR APPLICATION FORM <br />The Application must be typewritten or printed in BLACK INK Initial and date any changes you make on the form. <br />INCOMPLETE FORMS ARE NOT ACCEPTABLE AND WILL BE RETURNED. ATTACH ADDITIONAL SHEETS IF MORE <br />SPACE IS NEEDED. <br />FILING FEES: <br />S60 FOR EACH WELL PERMR APPLIED FOR. ONE WELL PERMff IS REQUIRED FOR EACH 'MUaD' PERMIT <br />AREA <br />IN ADDf110N, THE FOLLOWING FEES ARE REQUIRED TO EVALUATE THE SUBSTffUTE SUPPLY PLAN OR <br />AUGMENTATION PLAN: <br />$ 70 FOR PIT(S) TOTALING LESS THAN 10 ACRES OF SURFACE AREA. <br />$350 FOR Pff(S) TOTALING MORE THAN 10 ACRES OF SURFACE AREA. <br />K you have questions, contact the Darner or the Division Office where the pit is located. <br />1. Check the appropriate box for the classification d permit you are appying tor. A permit is not required if the <br />pit was constructetl prior to December 31, 1980 and has nd been reactivated. <br />2 Prim the owrret•s name and include the mailing address and phone number. <br />3. R the address of the local contact is different than the mailing address of the owner, then that information <br />should be included in this box. <br />4. The location must include 1l4, 1/4, Section, Township, Range and Principal Meridian. Check the appropriate <br />boxes for North or South and East or West directions. <br />5. Indicate the total number of acres d water exposed to the atmosphere and the total number of pits. <br />6. Indicate the proposed or actual total depth d the pit(s). <br />7. The proposext or actual dates d beginning and completion d excavation must be indicated. <br />8. The list of attachments to this application provides information which is necessary to the evaluation. A scaled <br />map of the pit area tied to a Section d 1/4 comer is required. Some d the items may not apply to your <br />particular instance. <br />9. ff exposed water is to be used for any purpose dher than evaporation, those uses must be detailed. The <br />information required includes but is nd limited to the amount d gravel mined, the use and method of diversion <br />d water, the pumping rate in gpm and the average annual amount d water diverted for the purposes described. <br />10. The pit owner or his designee must sgn the Statement. Print or type your name in the first block it it is <br />different from Item.No. 1. H signing as a represc~rtative d a corttparry who owns the pit, then your tole must <br />also be included in the first block. Sign the secontl block and date the last block. <br />DMSION 1 <br />209 ARIX BUILDING <br />800 8TH AVE. <br />GREELEY, CO 80631 <br />(303) 352-8712 <br />DIVISION 2 <br />279 W. 5TH RM. 223 <br />PUEBLO, CO. 81003 <br />(719) 5423368 <br />DIVISION 3 <br />422 4TH ST. <br />ALAMOSA, CO 81101 <br />(719) 5893683 <br />DIVISION 5 DIVISION 6 DMSION 7 <br />1429 GRAND AVENUE 320 UNCOW AVE. STE. E 1474 MAIN ST. <br />GLNWD SPGS. CO. 81601 STMBT SPGS., CO. 80477 DURANGO, CO. 81302 <br />(30.?) 945-5665,a (303) 879-0272 (303) 247-1645 <br />DIVISION 4 <br />308 S. FIRST ST, <br />MONTROSE, CO. 81402 <br />(303) 249-6622 <br />DENVER OFFICE <br />RM. 823 <br />1313 SHERMAN ST. <br />DENVER, CO. 80203 <br />(303) 6663581 <br /> <br />