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05/22/2009 11:45 3032748329 <br />BANKS AND GESSO LLC <br />PAGE 04/06 <br />Ir <br />(I <br />Form No. COLORADO DIVISION OF WATER RESOURCES For OM U <br />GWS-27 DEPARTMENT OF NATURAL RESOURCES <br />62006 1313 Sherman St, Rm 818, Denver, Colorado 80203 <br />Phone: (303) 866.9581 FEB 2 3 2007 <br />REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM <br />GRAVEL PIT WELL PERMIT APPLICATION '"s nrsa INMR o <br /> <br />1. <br /> <br />:PERMIT t;OLP. <br /> <br /> <br />.r <br /> NEW PIT(S) A <br /> D PIT(S) EXIST, CONSTRUCTED AFTER DEC, 31,1980 r <br />2. APPLICANT INFQRMATION <br />NAME(S) Cesev Concrete o <br /> <br /> Mailing Address PO Box 1815 <br /> City, St. Zip Aifl CO 81650 <br /> Phone( 970: ) 625-0746 <br />3. CONSM NT/ TTO O CO (If different than #2) <br /> NAME(S) Applegate Group. Inc. PIT NAME caseey Pits <br /> Mailing Address 1499 W. 120th Avenue, Suite 200 <br />DMG NO. M-1978-349 <br /> City, St Zip Denver. CO 80234 <br /> Phone( 303 ) 452-6611 <br />4. GENERAL NTY <br /> y? 1/4 /4, Sec. 11 Twp. 6 ? N. R] S., Range 93 ? E. X? W 6th P.M. <br />5. Estimated marammi, water surface to be exposed: 18.7 Acres. Number of Pits 5 <br />6. Estimated depth of pit(s) 30 Ft. Estimated depth to groundwater 5-10 Ft. <br />7. Estimated date to expose groundwater n/a : to complete mining 10 years _ <br />8. • (Check which have been attached.) <br /> (a) x Scaled map of pit area with range, bwnship, & section clearly identified (REQUIRED), <br /> (b) ? Copy of the reclamation permit. if applicable. <br /> (c) ? Copy of pre 1/16168 water conservancy diet. or water user assoc. augmentation agreement, If applicable. <br /> (d) ? Copy of proposed substitute water plan or augmentation plan application, N applicable. <br /> (e) Copy of court approved augmentation plan, if applicable. Case No. 03CW186 <br /> ? <br /> (t) <br />Other <br /> <br />9. Detailed description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amount of <br /> diversion of any waterwithdrawn from the pond. <br /> See decree in Case No. 03CW186. <br /> <br /> <br /> <br />10. 1(we) have read the statements made herein and know the contents thereof, and that they are true to my (our) <br /> knowledge. [Pursuant to Section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury <br /> in the second degree and is punishable as a class t misdemeanor.] <br />NamafMa (Please type or print) i nature <br />0,0 Date <br />beheld. E.we-L?k <br />For OIRae Use ony <br />Neu ?+ - I+?-h, <br />?`" x`11 <br />WD 3 Basin <br />MD Use I/? <br />S Co <br />Div <br />Court Case No <br />_ <br />. <br />. _ <br />.