2009-09-17_GENERAL DOCUMENTS - C1980001

• Permit No: C1980001
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 9/17/2009
• Doc Name: Change in Ownership/Address
• From: WWC Engineering
• To: Office of State Engineer
• Permit Index Doc Type: Exploration
• Email Name: JDM
• Media Type: D
• Archive: No

COLORADO DIVISION OF WATER RESOURCES Office Use Only Form GWS-46 (12/2007)
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST., RM 818, DENVER CO 80203
phone -info: [phone] main: [phone]
Fax: [phone],589 http://vmw.water.state.co.us
MONITORING/OBSERVATION
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.
1. Well Owner Information 6. Use Of Well
Name of well owner _............ _............ _.... __.._.__..._ ........................... --- _.......... .. _............ _.........
David and Marian Combs Use of this well is limited to monitoring water levels

._..._.....----.__.__..._....__..._._._...__ ............._T.___. and/or water quality sampling
Mailing address 7. Well Data (proposed)

P.O. Box 772461 _..... ........ .. .............................. ..._-.-.............. _......... ...._.._._.... _._.........................
Total depth - - - Aquifer
__ . _............ _. _........ _......... _. __............. ......... _..... ._......._........... ...............__..._........_._.._.........._.........._................
City State Zip code feet
15.5 Unknown
Steamboat Springs CO 80477 8. Consultant Information (if applicable)

Telephone # i E-Mail (Optional) _. ...... __ _...._ .............. _..---............... _......... -----.................... _..................... _....... _...... -................................
.. _._..... _......... _....
Name of contact person
[phone] Troy Summers
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2. Type Of Application (check applicable boxes) .
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_.
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.................. ...._.._...... _..................... ...._...._......... __................... _...................... _.._............ _....
company name

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_..._..................._...._................. _.._..............
® Use existing well ? Replacement for existing monitoring well:

WWC Engineering
................................
? Construct new well Permit no.:Not Permitted Mailing address
? Other: 611 Skyline Road
-. ................. _.._............... _............... _......_........-.............. _..... _..... _._.................. ---.......... _.......... __........ __-................
_...__...
3. Refer To (if applicable) city State Zip Code
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Monitoring hole acknowledgment Well name or #
Laramie WY 82070

MH- N/A TR-3 _..- ........................--..............__..................-_..............._.....................__.._.........._..-.............................-'_-_...._._. _...................
...........
Telephone # __..-..........._._
4. Location Of Proposed Well [phone]
County 9. Proposed Well Driller License #(optional):N/A
Routt SE 1/4 of the NE 1/4 10. Signature Of Well Owner, Consultant Or Authorized
.................. ....._... __._........ -....---._.....
_..._...._.__....._. _....._........... _......... ._.........._ __ .._.............................._
Section ( Township N or S Range E or W Principal Meridian

gent

36 5 ®? 86 ? ® 6 _....... ..... _ .................... _.._..........._._..__..........._._-....... _-........_..................._._.......... _..................... _._................
_................... .............._.................. .............
The making of false statements herein constitutes perjury in the second
degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S.
............ _... -._..._._.. _ ............. ------- _.............. ......... __......... .......... -_.._...... __............. _.._.......... _..... .__.._........................
_............. ............................ ___ 24-4-104 (13)(a). I have read the statements herein, know the contents
Distance of well from section lines (section lines are typically not property lines) thereof and state that they are true t.omY. knowled e.
...................-............__..__.
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1445 Fl. from ® N ? S 89.8 Ft. from ® E ? W _ _ _
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Sign here (Must b ginal 'nature) Date
For replacement wells only- distance and direction from old well to ne...... ell .___ - - ' 9 151 ag
N/A feet N/A direction rint nar,e a iitle.._..._`- ...... ................. -.... _..__._...._........-........ _.................... _.... .._.__.. ...... _......... __........._.._..._.__..._......
._._......._...._..
..-....... -......... .... _._....---.._.-_. ....... ._...... ....____........ ---..................... _.-- --........
Well location address (Include City, State, Zip) ? Check if well address is same asltem 1.
-Tp2 D t .<m 'nvj AW4X rA Q u76?3T

N/A
----...._..... ........ ------ ---.... _.......... _---..... _..._.--.................... - ---------..__............
Office Use Only
Optional: GPS well location information in UTM format
You must check GPS unit for required settings as follows: USGS map name DWR map no. ; Surface elev.
Format must be UTM i
? Zone 12 or ® Zone 13 Easting 332234.02 Receipt area only
Units must be Meters
Datum must be NAD83 Northing 4468505.67
Unit must be set to true north
Was GPS unit checked for above? 10 YES Remember to set Datum to NAD83
5. Property Owner Information
-..._...._?._. _....._.......-- .._..._........._ --_ ... _...._...........- -..._.._-.......... _......
Name of property owner ----.........................
David and Marian Combs
..... ..............---............._....__._._...._____-.................._...... - -.._._._........................._
Mailing address
P.O. Box 772461 l ...................................._.......__._._.__..___.__.
............_._---......... -._.... _......... __ .................. --.......................... __...__..-.___..... .............. _...__....................................
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City State Zip Code
Steamboat Springs CO 80477
_-._.... -..... _.._..._......._..........
Telephone #
[phone] DIV WD BA MD