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F o R M COLORADO DIVISION OF WATER RESOURCES I For office use only <br />No. <br />C'am' 27 ~ DEPARTMENT NATURAL RESOURCES <br /> <br />12195 1373 Sherman St., ~18, Denver, Colorado 80203 <br /> phone: 13031866-3 <br />REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM <br />GRAVEL PIT WELL PERMIT APPLICATION <br /> TYPE OF PERMIT <br /> ^ <br /> NEW PITIS) <br /> ^ PITIS) EXIST, CONSTRUCTED AFTER DEC. 31, 1980 <br />2. APPLICANT INFORMATION <br /> NAME(S) Lt7stern Dtobile, a subsidiary of IafarQe Corn. <br /> Mailing Address 1590 )test 12t}t Avenue <br /> City, St. Zip llenver, Colorado 8 0 204-34 10 i <br /> <br /> Phone) 303 ) 657-4331 <br /> <br />3. CONSULTANT/ATTORNEY/OPERATOR CONTACT (lf different than aY2) <br /> NAME(S) Tuttle Artnlegate PIT NAME Tanabe Pit <br /> Mailing Address 11990 GRant Street, Suite 304 <br /> City, St. Zip Denver, Colorado 80233 DMG N0. 00-002 <br /> <br /> Phone) 303 1 452-fifi11 <br />4. GENERAL LOCATION OF PITISI: COUNTY Adams <br /> nn <br />NLV 1 /4 NW 1 /4, Sec. 10 Twp. 2 ^ N. LX~ S., Range_(~ ^ E. ®W. fith P.M. <br />5. Estimated maximum water surface to be exposed: 1.2 Acres. Number of Pits 1 <br />6. Estimated depth of pills) 25 Ft. Estimated depth to groundwater 15 Ft. <br />7. Estimated date to expose groundwaterMay 2000 ; to complete mining 2007 <br />8. ATTACHMENTS: (Check which have been attached.) <br /> lal X^ Scaled map of pit area with range, township, & section clearly indentifed (REQUIRED-. <br /> Ib) ^Copy of the reclamation permit, if applicable. <br /> Icl ^Copy of pre 1/15/89 water conservancy dist. or water user assoc. augmentation agreement, if applicable <br /> Idl ®Copy of proposed substitute water plan or augmentation plan application, if applicable. <br /> lel ^Copy of court approved augmentation plan, if applicable. Case No. <br /> ^ <br /> Other <br />Ifl <br /> <br />9. Detailed description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amoun <br /> of diversion of any water withdrawn from the pond. <br /> Dust control- 2.0 acre-feet• moisture in mined material - 10.3 acre-feet_• <br /> <br /> <br />0 I (wel have read the statements made herein and know the contents thereof, and that they are true to my lour) <br /> knowledge. [Pursuant to Section 24-4-104 11311a) C.R.S., the making of false statements herein constitutes perju <br /> in the second degree and is punishable as a class 1 misdemeanor.] <br />. Name/Title (Please type or print) Signa Date <br /> <br />_=.-~ . ay Lli. gal /l,~a ~; - ~ ./ - <br />For Office Usa only <br />Court Case No. Div. _ Co. _ WD _ Basin _ MD Use <br />