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� � � � � � � � � � � � � �r � � r � � <br />Well Use Information for Plan Year <br />Please complete the following application in its entirety to provide sufficient information for the well augmentation plan. �you use vour well(s) for inside use or for stock, <br />please make sure vou snecifv below!! Any AGUA well that u requesting to pump during the 2003 Plan Year for domestic use, municipal use or some other type of use (not <br />irrigation) not able to shut down, must provide the following information: ID number, use of the well (domestic, municipal, stock etc.), eacplanation of why it can't shut <br />down, If the well had previously been used partially for irrigation-note the past irrigatiort use and percentage, but indicate the non-irrigation use separately as the request <br />for the 2003 Plan Year on page 6 of this application!!!! Those applications not filled out properly will be rejected and sent back for completion. <br />2. 3. 4. 5. 6. 7. 8. 9. 10. <br />STATE INACTIVE *IItRIGATION * WELL USE: Do You use any ff Yes, what Shares Acres How Much IS THIS WELL BEING USED FOR <br />STRUCTURE OR ACTIVE METHOD: Irrigation, surface (Ditch) ditch associated with irrigated by Lawn does the INSIDE USE OR TO WATER STOCK7 <br />ID For Plan Yeaz Flood, Commercial, water rights with company is those rights. If this well. If water from this If non-irrigation, describe the uses of the <br />Sprinkler, etc. Municipal, this well? Yes or used? Applicable. Applicable. well go to? (in well and where does the water go? You <br />Include what % Household etc. No. If yes, answer squaze feet) If may use the remainder of the grid if more <br />of each used. Mark All That the next two Apalicabie. detailed information is needed. If <br />If applicable Apply. Include colucnns also. applicable, please write down how many <br />% of each used homes this well supplies and if you use a <br />w/each well. se tic s stem or city sewer. <br />Use as much space as you need! The more information you provide, the better we can serve you! <br />*KEY: Irrigation Method: flood, sprinkler, (N/A) Not Applicable. Well Use: irrigation, livestock, household, municipal, commercial (please describe), stock (how many), <br />other (please describe). <br />Do you own or lease any water, for the use of this well, from sources other than AGUA? If yes, where and how much? <br />