PROJ02063

• Contract/PO #: C150234
• Contractor Name: Headgate 396 Lateral Corporation
• Contract Type: Loan
• Water District: 72
• County: Mesa
• Loan Projects - Doc Type: Feasibility Study

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COLORADO WATER CONSERVATION BOARD
CONSTRUCTION FuND LOAN APPLICATION

Instructions: This application should be typed or printed neatly with black ink. Attach additional
sheets as necessary to fully answer any question or to provide additional infonnation that would be
helpful in the evaluation of this application. When finished, please return this application to:

THE COWRADO WATER CONSERVATION BoARD
Water Supply Planning and Finance Section
1580 Logan St., Suite 750
Denver, CO 80203
Attn: Kirk Russell, P.E. or Bruce Johnson, P.E.
Phone Number 303/866-3449 - Fax Number 303/894-2578
e-mail: [e-mail]@state.co.us

Part A. - Description ofthe Applicant (Generally, the applicant is also the prospective owner and
sponsor of the proposed project. If this is not the case, please contact the CWCB staff before
completing this application.)

1. Name of applicant Hea e:/, 41 e L 6...fe ra../ "3 r b Cor ~orO-'f-, ON

Mailing Address 2 I 2 S I fz R. 0 G ,

Business Phone Number (97c) '2 ~/ - SODCfFax Phone Number ( )
Federal ill Number "2 D -1 S" t) B 0 II> D e-mail Address

2. Person to contact regarding this application:
Name D4 ve. Me::. D ONClld
Position!Title
Address q 2 L/ 2-1 K oe: cI
Business Phone Number ('j70 ) 2. , ~ f()cIj Home Phone Number (170) :).. L/ S" -12 J </
e-mail Address
3. Type of organization (Ditch Co., Irrigation District, Municipality, etc.): D l fGA L.c .
Date of Annual Meeting )."~ ~"L ,I) ::1A:/\/
Is the organization incorporated in the State of Colorado? YES v/ NO _ (If YES, please
include a copy of the articles of incorporation, and the bylaws with this application fonn.)

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