2006-09-19_REVISION - C1982056

• Permit No: C1982056
• IBM Index Class Name: REVISION
• Doc Date: 9/19/2006
• Doc Name: Review of Applications for a Water Well Permit
• From: Twentymile Coal Company
• To: Water Resources
• Type & Sequence: TR61
• Media Type: D
• Archive: No

COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-45 (06/2006)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST, RM 818, DENVER, CO 80203
phone - info: [phone] main: [phone] fax: [phone]
hftp://vmw.water.state.co.us
GENERAL PURPOSE
Water Well Permit Application
Review instructions on reverse side prior to completing form.
The form must be completed in black or blue ink or typed.
t Information
li
A 6. Use Of Well (check applicable boxes
can
1.
pp f
Name of applicant or.
Attach a detailed description of uses applied
/t
Two ?/ ?i ?? l QA ?4 h' n y M Industrial ? Other (describe):
? Municipal
MailinQ,addraw /?
L g $r / s R0 f '_ Cq w, 4 t2a 4?2 7 ? irrigation
city state zp ? Commercial

Ca k Cie e,? CO 6 7
a

ll Data (proposed)
7. We
Telephone # Email (Optional) /
[phone] W6l7;er M 4d ene Mabmum pumping te Annual amount to be withdrawn
o+ ?O(? gpm 3C? ' acre-feet

2. Type Of Application (check applicable boxes) Total depth Aquifer
? Construct new well Use existing well f 3 (o 5. 5- feet I qw?/h ! ?e SRr'?'S? ne..
? Replace existing well [I Change or increase use
r) ? Reapplication (expired permit)
if g, Land On Which Ground Water Will Be Used
e
? Change source (aqu
? Other: Legal Description (may be provided as an attachment):
3. Refer To (if applicable) Under qw? n,p„,4e,-4pr% pbcn lecree-
Well permit # Water Court case #
use nb. 9? o w ? 9
Designated Basin Determination # Well n m
ae or #/
/0 9r
4. Location Of Pro osed W ell (If used for crop irrigation, attach a scaled map that shows irrigated area.)
county va m the N /i?/ ,l< A# qc B. Owner
Tr.?fi»
I (-e C" / CIO .
Section Township N or
- Range E or W Principal Meridian
?
c (G n
C. List any other wells or water rights used on this land:
7
! ' O
V
ion lines
li
i are typically not property lines)
nes (s
on
Distance of well from sect
./
.1 Ft.from [3N ? S 235 - Ft.from ? E Ly W
9. Proposed Well Driller License #(o tional :
For replacement wells only- distance and direction from old well to new well 10. Signature Of Applicant(s) Or Authorized Agent
feet direction The making of false statements herein constitutes perjury in the second
R
S
nt to C
Well location address (Include City, State, Zip) heck if well address is same as in item 1. .
.
.
degree, which is punishable as a class 1 misdemeanor pursua
24-4-104 (13)(a). I have read the statements herein, know the contents
thereof and state that the are true tom knowled e.
Sign here (Must be orlglnal signature) Date
Optional: GPS well location information in UTM format You must check GPS unit for
f
ll
ws:
i ?, ?/? 7h/U ?
o
ngs as
o
required sett

e UT
Format must b
0 Zone 12 or zone 13

` ? , ?,
Easting 23 Print name s title
1 ^/
?r V ?1 -? s/??1 C r, /0
Units must be Meters
Datum must be NAD83 ?i
Northing tt 7 Office Use Only

DWR map no. Surface elev.
Unit must be set to true north ? USGS map name
Was GPS unit checked for above? j `J YES Remember to set Datum to NAD83 -
5. Parcel On Which Well Will Be Located Receipt area only
(PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL

A. Legal Description (may be provided as an attachment):
C/7 Cc 0 U rii (Z oo 2.70 0
vW2ME41 NW41 tV2Slu4 4) NW4Sc4)
SEG 2. i - S: MTA 1- 3?0 p-

B. # of acres in parcel
0 66 C. Owner
wee{ n,i k COO / Co . WE
wR
D. Will this be the only well on this parcel? ES ?NO (if no - list other wells) CWCB
TOPO

E. State Parcel ID# (optional): MYLAR
SB5 DIV WD BA MD