2012-02-13_PERMIT FILE - X200923100

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COLORADO DMSION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST, RM 818, DENVER, CO 80203 phone - info: (303) 866 -3587 main: (303) 8663581 fax (303) 866 -3589 http: //www.water.state co us Office Use Only � RE r'efkV ) yS 45 (0712009) JAN 2 8 2010 WATER RESOURCES &TAT E OLO.NAER GENERAL PURPOSE Water Well Permit Application Review instructions on reverse side prior to completing form. The fomi must be completed in black or blue ink or typed. 1. Applicant Information 6. Use Of Well (check applicable boxes) Nacre of applicant Colorado Board of Land Commissioners Attach a detailed description of uses applied for ® Industrial ❑ Dewatering System ❑ Munici ❑ Geothermal (0 production or ❑ reinjection) ❑ Irrigation ❑ Other (describe ): Use for mine facilities (office and ❑ Commercial bathhouse) address Mating PO Box 1194 City Craig State CO Tip code 81626 7. Well Data (proposed) Telephone * ( 97U) 824 -2850 I rran (Opbad I lane.osbom(cQstate.co.us Maximum pumping rate 10 gPm Annual amount to be wltl�awn 10 (estimated maximum) acre - feet 2. Type Of Application (check applicable boxes) Total depth 500 feet Aquifer Trout Creek Sandstone [y Construct new well ❑ Change source (aquifer) ❑ Replace existing well ❑ Reapplication (expired permit) ❑ use existing well ❑ coGCC well ❑ Change or increase use ❑ Other 8. Land On Which Ground Water Will Be Used Legal Description (nay be provided as an attachment). ()t used for cropgabon attach a scaled map that shows irrigated area.) 3. Refer To (if applicable) Wel permitf Water Court case f Designated Bash DeimiatIon f Wen nave or* 4. Location Of Proposed Well (Important! See Instructions) County Routt NE 114 of the NE 114 A. f Aces N/A B Owner N/A Section 3 Township N or S l 5 ®❑ Range E or W 87 ❑ ® Prmupal Meridian PM C. List any direr wells or miter rights used on this land. N water rights listed for that section g Distance of mores ic welt from section res (sedlon es are typically not property floes) ) 538 Ft tom b] N ❑ S 464 Ft. horn [R1 E ❑ W 9. Proposed Well Driller License #(optional): For replacement wens ody - dstance and direction from oat well 10 new well feet direction 1 0. Signature Of Applicant(s) Or Authorized Agent The making of false statements herein constitutes pequry 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 thereof and state that they are true to my knowledge Wen bullion address (include cry, state, an 2 check if well address is same as w !tern 1. Sign here ( signature) 1 Date I Optional: GPS well location Information In UTM format You must check GPS tali for required settings as follows: Format mat be UTM El Zone 12 or ® Zone 13 Urals must be Meters Datum must beNADe3 Una oust be set b true norm Was GPS ura sheared for above? ® YES Easttng 319,602 Print name & de .(4N,6 .'E ,1 /Vie. n *04 /V / vAtt'N&/etYT.H3)ai[Y / Yi e. �TA4'71Plerwha mes, Notifying 4,477,132 Office Use Only � Remember to set Dalian to NADB3 USGS map name - Pit 14,4- 4 70 Co. 4 A. DWR map no Surface Net 5. Parcel On Which Well Will Be Located (YOU MUST ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) ✓ , 1+ �� c r� ` _ � ( /b'Iwi FOC, 7a-- / A Pion, Receipt area only O 6 8 1 gQ 13 A. Legal Description (fray be provided as an attachment): STATE OF COLORADO (STATE BOARD OF LAND COMMISIONERS) T5N R87W IN SEC 1 -3, 10 -12, 5 -87 AoUAMAP . as TIa.- y � x t a WR Q aQ 1 ,L) ,j '4 G� ma ✓ l , TOPO till a OF i Q MYLAR Sas DIV 6 WD 5 / BA MD B if of saes it parcel 8.39 C. Owner State of Colorado D. wit tNsbe tie only sell onttas parcel? EYES ONO (if no — list other wens) TO BE ONLY WATER - RIGHTED WELL ON PARCEL. OTHER WELLS ON PROPERTY FOR MONITORING PURPOSES ONLY (SENECA COAL) E. state Parcel 105 (comer): Parcel # 944024001, Account # R0051237 'box /Oyy