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Form No. <br />GWS -27 <br />5/2011 <br />COLORADO DIVISION OF WATER RESOURCES <br />DEPARTMENT OF NATURAL RESOURCES <br />1313 Sherman St., Room 821, Denver, Colorado 80203 <br />Phone: (303) 866 -3581 Fax: (303) 866- 3589 <br />For Office Use only <br />REVIEW INSTRUCTIONS PRIOR TO COMPLETING FORM <br />GRAVEL PIT WELL PERMIT APPLICATION <br />1. <br />TYPE OF PERMIT <br />DEC. 31, 1980 <br />X <br />NEW PIT(S) <br />� <br />"1 PIT(S) EXIST, CONSTRUCTED AFTER <br />2. <br />APPLICANT INFORMATION <br />NAME(S) <br />Mailing <br />City, <br />Phone <br />Transit Mix of Pueblo <br />Address 444 E Costilla St. <br />St. Zip Colorado Srpings, CO 80903 <br />( 71 9 ) 475 -0700 <br />3 . <br />CONSULTANT /ATTORNEY /OPERATOR CONTACT (If different than #2) <br />PIT <br />DMG <br />NAME Pueblo East P: <br />' NAME(S) <br />Mailing <br />City, <br />Phone <br />Bishop— Brogden Associates, Inc. <br />Address 333 W . Hampden Ave . , #105 0 <br />NO. M-1986-015 <br />St. zip Englewood, CO 80110 <br />( 303 ) 806 -8952 <br />4. <br />GENERAL LOCATION OF PIT(S): COUNTY Pueblo <br />ri E. W. P.M. <br />see Attachment 1 <br />1/4 1/4, Sec. Twp. U N. ri S , Range <br />5. <br />Estimated maximum water surface to be <br />exposed: 1 3.3 Acres. Number <br />of Pits 3 . <br />6. <br />Estimated depth of pit(s) 37 Ft. Estimated depth to groundwater 1 0 Ft. <br />7. <br />Estimated date to expose groundwaterFebruary 1 , 201 2 ; to complete mining December 31 , 2015 <br />8. <br />ATTACHMENTS: (Check which have been <br />attached.) <br />range, township, & section clearly identified <br />if applicable. <br />conservancy dist. or water user assoc. augmentation <br />water plan or augmentation plan application, <br />plan, if applicable. Case No. <br />(REQUIRED). <br />agreement, if applicable. <br />if applicable. <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />Scaled map of pit area with <br />+(X l <br />lJ Copy of the reclamation permit, <br />[1 Copy of pre 1/15/89 water <br />[1 Copy of proposed substitute <br />E Copy of court approved augmentation <br />( <br />I ( Other <br />9. <br />Detailed description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amou <br />diversion of any water withdrawn from the pond. <br />See Attachment 1 <br />10. <br />I (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 1 misdemeanor.] <br />Name/Title (Please type or print) <br />Paul Bss <br />Water Resource Enaineet. <br />Re <br />Signature <br />Z4,-.0....--- <br />Date <br />��01[3-01( <br />For Office <br />1 Court Case <br />Use only <br />No. Div. Co. WD Basin MD Use <br />_ <br />