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<br />'-i <br /> <br />COLORADO WATER CONSERVATION BOARD <br />CONSTRUCTION FUND GRANT ApPLICATION <br />. I <br /> <br />Instructions: This application should be typed or printed neatly with black ink. Attach additional <br />sheets as necessary to fully answer any question or to provide additional information that would be <br />helpful in the evaluation of this application. When finished, please return this application to: <br /> <br />Colorado Water Conservation Board <br />Attn: Water Supply Planning and Finance Section <br />1313 Sherman Street, Room 721 <br />Den ver, CO 80203 <br />Phone: 303/866-3441 Fax: 303/866-4474 <br />e-mail: John.VanSciver@State.CO.US <br /> <br />Part A. - Applicant Information. Generally, the applicant is the Project Sponsor or Owner. If this <br />is not the case, please contact the CWCB staff before completing this application. <br /> <br />1. Narneofapplicant To~JJ DF IArELUJJ.bTo~ <br /> <br />2. <br /> <br />Mailing address 1:> c>. ~o~ 12.1- I '3 t ~ s t:ievE ~ A- Lltn1u.E <br />LU eLLrA-l ~-rf')A.J 1 ~D ~o5~9 <br />Business Phone Number tt":\tD - 5/'~' ~3'O( Fax Phone Number(\io, 5t,B - 43 -s'-l <br />Taxpayer ID No. e-mail address <br /> <br />.., <br />:). <br /> <br />Person to contact regarding this application: <br /> <br />Name LA-{2..~\, Ll>r el1 t7:e-~ <br /> <br />Mailing address 1 SArV'1C <br /> <br />Business Telephone ( )~ Home Telephone ( ) <br /> <br />Type of organization (Ditch Co., Inigation District, Municipality) <br /> <br />M T.+'O <br /> <br />Is the organization incorporated in the State of C lorado? YES -t- NO_ <br /> <br />If YES, please include a copy of the articles of incorporation and the bylaws with this <br />application form. <br /> <br />Please provide a brief description of the owner's existing water supply facilities. Attach <br />separate sheets and a map, if needed. c:::r--~ -r~ k.bo.-s. A~t> o;p Lc:.bA <br /> <br />tovvtt.:>L F-J4~ irh~ . <br /> <br />Position/title 'Tb'-\n\ Abt'Wi/'\j~~ <br /> <br />r <br /> <br /> <br /> <br />4. <br /> <br />5. <br /> <br />6. <br /> <br />For existing facilities indicate: <br />(a) Number of shareholders J-4/A <br />(c) Current ~sessment per share $ "'/A <br />(d) the number of customers served /VIA <br />, <br /> <br />(e) Average monthly water bill $ <br /> <br />""fA <br /> <br />, <br /> <br />(b) Number of shares N /A <br />