Laserfiche WebLink
•WRJ~S•Rev.16 COLORADO DIVISION OF WATER RESOURCES ~F.lr~~~~~IV <br /> 818 Gsentennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br /> rn~ ?. ,r91 <br /> PERMIT APPLICATION FORM <br /> <br />Application must __ <br />N.57f., i,r,,0`,,,wM <br />be complete where ( 1 A PERMIT TO USE GROUND WATER s~r..-r:;;~,;•r~~R <br />applicable. Type or ( ) A PERMIT TO CONSTRUCT A WELL "'i0 <br />print in BLACK FOR: ( 1 A PERMIT TO INSTALL A PUMP <br />INK. No overstrikes <br />or erasures unless ( 1 REPLACEMENT FOR N0. W <br />initialed. (X)OTHER Nina DPwa prang wP11 ~ari cring) ~ <br /> WATER COURT CASE N0. <br /> <br />(1) APPLICANT -mailing address <br />Energy Fuels Coal„ Inc. <br />NAME Attn; Allen S. Weaver <br />STREET P•0. Box 449 <br />CITY Florence, CO. 81226 <br />(Slate) (z,ol <br />TELEPHONE N0.~~719) 784-6395 <br />(2) LOCATION OF PROPOSED WELL <br />County Fremont <br />NW '/. of the SW 'G, Section' 19 <br />Twp. 20 S Rng. 69 W 6th P.M. <br />IN.51 IE,wI <br />(3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate (gpm) <br />140 <br />Average annual amount of ground water <br />to be appropriated (acre~feetl: <br />Number of acres to be irrigated: N / A <br />Proposed total depth Iteet): <br />Aquifer ground water is to be obtained from: <br />Coal Seam-Abandoned mine workines <br />Owner's well designation North Dewatering Well <br />GROUND WATER TO BE USED FOR: <br />( )HOUSEHOLD USE ONLY ~ no irrigation (0) <br />( )DOMESTIC (11 ~~ l 1 INDUSTRIAL (51 <br />( )LIVESTOCK (2)~ 1 )~I R~RIGAYION (61~ <br />( )COMMERCIAL (A) ( )MUNICIPAL (81 <br />(gIOTHER(9)Mine Dewaterinfi <br />DETAIL THE USE ON RACK IN (11) <br />(4) DRILLER <br />Name N/A <br />Street <br />City <br />Islalel (zial <br />Telephone No. <br />Lic. No. <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUM <br />Receipt No.l ~..~~~t.7 7 ~ / <br />Basin <br />Dist. <br />CONDITIONS OF APPROVAL <br />This well shall he used in such a way as to cause <br />no material injury to existing water rights. The <br />issuance of the permit does not assure the applicant <br />that no injury will occur to another vested water <br />right or preclude another owner of a vested water <br />right from seeking relief in a civil court action. <br />APPLICATION APPROVED <br />PERMIT NUMBER <br />DATE ISSUED <br />EXPIRATION DATE <br />(STATE ENGINEER) <br />BY <br />I D ~ ff111NTV ~`x' ~~ <br />L <br />~L <br />I <br />i <br />i <br />