2011-01-24_PERMIT FILE - M2011007 ‎(7)‎

• Permit No: M2011007
• IBM Index Class Name: PERMIT FILE
• Doc Date: 1/24/2011
• Doc Name: New 110d Appl.- Ex. C, Mining Plan to EPA Data
• From: Venture Resources
• To: DRMS
• Media Type: D
• Archive: No

,?
?-C4 RADO DIVISION OF WATER RESOURCES
DEPARTMENT OF NATURAL RESOURCES
1313 SHERMAN ST., RM. 818, DENVER CO 80203
phone - info: [phone] main: [phone]
RESIDENTIAL* lNote: You may also use this form to apply for livestock watering)
L4
(i RECEIVED
5jV7f MAY 021997
STERRE.,;bURS
Water Well Permit NOWNtion
. ?_ .r.-a..-i :.. 1.1-1, ;n4 nr tvnari
Review instructions prior to con letup torn •••?-- -_ -- ---- -
USE OF WELL (check appropriate entry or entries)
6
1. APPLICANT INFORMATION .
See Instructions to determine use(s) for which you may qualify --
Name of applicant A. Ordinary household use in one single-family dwelling
PAUL R. WELCH (NO outside use)
MailirpAddress ? 8. Ordinary household use in 1 to 3 single-family
dwellings:
P.O. BOX 211 Number of dwellings:
Bute zip code ? Home garden/lawn irrigation, not to exceed 1 acre:
CRY
80427 area irrigated ? sq. ft. ? acre
TNephww Numbdx flroluie we@ nodal ? Domestic animal watering - (non-commercial)
(qQ:!) 699-0994
2. TYPE OF APPLICATION (check applicable box(es)) ? C. Livestock watering ton farm/ranch/ronge/pasture)
ll ? Use existing well 7. WELL DATA
C(Construct new we mou m to be witlldrswn
l
A
13 Replace existing well 13 Change / increase Use Maximum pumping rate trua
e
acre-feet
r 13 Reapplication(expired psmlit)
if f#pm
e
C1 Change (source) aqu WMr
A
? Other: Total depth g
/'
P'wrl?r
3. REFER TO (if applicable):
water court case # Permit Od feet
8. TYPE OF RESIDENTIAL S t-? "
EWAGE SYSTEM
U Septic tank / absorption leach field
verbal i Monitoring hole acknowledgment # ? Central system
-VE- MH- District name:
Well name or ? Vault
Location sewage to be hauled to:

4. LOCATION OF WELL ? Other (attach copy of engineering design)
County Quartedquoner Quarter 8. PROPOSED WELL DRILLER (optional)
G I L P I N " . Y. /?I!F Y. Name ueene twmber
Section Townshipkor s Range Eor W principal Meridian CR SMITH DRILLING
22 * licant(s) or authorized agent
f
NATURE
-,
3 ?
7 ?
1
b
o
app
10. SIG
Distance of well from section rmes The making of false statements herein constitutes perjury
f7 ft. from K N ? S ft. from IDE ? W in the second degree, which is punishable as a class 1 mis-
Well location address, if different from applicant rasa of avplicawe) demeanor pursuant to G.R.S. 24-4-104(13)(x). I have read
the statements herein, know the contents thereof and state
For replaaanent wads only - d@stanoee and direction from aid wall to new well that they ar true to my knowledge.
feet direction lui 't be -w Xan"ua 1,77
5. TRACT ON WHICH WELL WILL BE LOCATED
A. You must check one of the following - see instructions
Title owe
Name
i
i
i
? OWNER 04Z21 /Q17
on:
v
Subd
s
Filing/Unit
Block no
L OPTIONAL INFORMATION
.
ot no.
? County exemption (attach copy of county approval & survey)
uses mw name
oVVR m.p ne,
surface ehv.
Tract no.
/no
N
.
ame
%XMining claim lattach copy of deed or survey) Office Use Only
DIV
Name/no.IRON WEST 41 t 050297
415,165 N
13 Other iatuch legal description to appticationl a.?
CHEEKS V r
UIV OF 4ATER RESOXER N 1
B. STATE PARCEL
WD V7,
ID# (optional):
C. *acres in tract D. Are you the owner of this property?
I
+/- X13YES ? NO (if no - see detailed inst.) BA
-
Will this be the only well on this tract?
E
.
X7?YES ? NO (if other wells are on this tract - see detailed inst.) USE MD
Form GWS-44 (11/95)