PERMFILE133645

• Permit No: C1981014
• IBM Index Class Name: Permit File
• Doc Date: 12/11/2001
• Doc Name: AIR EMISSION PERMITS
• Section_Exhibit Name: EXHIBIT 04 Part 3
• Media Type: D
• Archive: No

- ...:
JWRJ-S-Rev. 76 COLORADO DIVISION OF WATER RESOURCES '-t ~~,~1~0~
818 Csentennial Bldg., 1313 Sherman St., Denver, Colorado 80203
fin 1 il'91
PERMIT APPLICATION FORM
pplication must ~ ~,; ,,,,,,..,,
µ'tl' ~ ~ ""0` ""`"
com lete where
P ( 1 A PERMIT TO USE GROUND WATER S7i~i"r fl:::;::~cR m
pplicable. Type or ( ) A PERMIT TO CONSTRUCT A WELL "`:0 `6
print in BLACK FOR: ( ) A PERMIT TO INSTALL A PUMP
INK. No overstri kes
or erasures unless ( 1 REPLACEMENT FOR NO. w
initialed. (X)OTHER Ni nE• P ruatarins LdPll (~icting)
G
l
WATER COURT CASE N0. ~

(1) APPLICANT-mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMNy
Energy Fuels Coa1,.Inc. M
NAME Attn; Allen S. Weaver /
Receipt No.\~°.,?_'Y~~~7~ / tU

STREET P•0. Box 449 U
ti
Rosin Dist
.
o.
Florence, CO. 81226 'm
CITY
(Stale) Iz~ol CONDITIONS OF APPROVAL
m
TELEPHONE NO. [phone] This well shalt he used in such a way as to cause
no material injury to existing water rights. The
(2) LOCATION OF PROPOSED WELL issuance of the permit does not assure the applicant
that no injury will occur to another vested water
right or preclude another owner of a vested water
County Fremont right from seeking relief in a civil court action.

NW +/, of the SW '/., Section' 19
Twp 20 S Rng, 69 W 6th P.M.
IN,51 IE.WI
~3) WATER USE AND WELL DATA
Proposed maximum pumping rate (gpm) 140
Average annual amount of ground water ~
to be appropriated lacre-feet): 25
Number of acres to be irrigated: N ~ A
Proposed total depth (feet): 38~
Aquifer ground water is to be obtained from:
Coal Seam-Abandoned mine workin_~_
Owner's well designation North Dewatering Well
• GROUND WATER TO BE USED FOR:
( 1 HOUSEHOLD USE ONLY - no irrigation (O)
( )DOMESTIC 111 ( 1 INDUSTRIAL 151
LIVESTOCK~~121~ ~ ( )~IRRIGA710N IGI-~ ~ "'
( 1 COMMERCIAL 141 ( 1 MUNICIPAL (81
I g) OTHER i91 Mine Dewaterin>; APPLICATION APPROVED
DETAIL THE USE ON RACK IN (11)
(4) DRILLER
~me NSA
ZFreet
City
(Slate) IZIQ)
Telephone No
Lic. No.
PERMIT NUMBER
DATE ISSUED
EXPIRATION DATE
(STATE ENGINEER)
RY
LD. ~ COUNTY ~ "~`- ~ ~~
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