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<br />COLcm..A,DO WA TER CONSERVATION BOARD <br />CONSTRUCTION FUND LOAN ApPUCA'ilON <br /> <br />Instructions: Thi" application shouid be typed or printed ne:Jtly witl1 black ink, /\!tach Jdditicrml <br />sheeb a~ necessary to fully answer any question or 10 provide additional infcnnation that would be <br />heipfu! in the evaluation of this application, 'When t1nished, please rdurn this application to: <br /> <br />TilE COLORADO WATEll COI'SERVATION BOARD <br />AHn, John V'/, V;:;n Seiser <br />l5S0 Logan St., Suite 750 <br />Dwwr. CO 80203 866-)449 <br />Phone NW1',bu (303) &9<;..2-5:;r~ Fa" Number (303) 894-2578 <br />euEnail: jnhn. vansciver(~)stale.c(),us <br /> <br />Pm1 A. - Hcsc.-iption of the /\ppiicatlt !,Generaily, the applicm1t is also the prospective owner and <br />~pon~nr of the p:.oposcd prc~iect. If this i~ not tbe case. please CODluct the C\VCB stnff befo[-.: <br />c\.xnplet;ng this application.) <br /> <br />I. Narne ofnppJicant kestcrn Area rD"';~Ter Administr;.;,timl, Colorado fU'ier_ StCJ_T;J.f!,(I;n_ <br /> <br />nP:ccJgct._Hnn..:j.J2;emeI,t (;~11ter <br /> <br />1'v131 1 i ng Address"mL':...Q_:n__~Q_:~,___LL2JL9J..m:?J'c L UT . n i3 41_,~ 7 -0 6 () 6 <br /> <br />1i_r;_~~g~_r;m.0._~l!L;;_~.Si'~_!n_n_J_5._Q__X_~nn~~_S!_~jJ!_:lmn!:~Ltn6~~~~:_~_Lm~:~~i!_~n_}~~gn'._ S _~~~_~_~)T-3A_~:= 1 53A__ <br /> <br />Business Phone NW11ber (mB_~!.Lt?.?':~L::_(:J.z~~.mm_. <br /> <br />Fax Phone NUTI1her (.~S!Ln).)_;?~_::;?g}Jnn__mmm____ <br /> <br />l'ederallD NlHnbecmm__mmm__nmmn_,mmn_nmm_, <br /> <br />c-rnaiJ Address m~L~_~:_~:~:.ilQ:.:L~~J2.0n~_gg::~mm__mmm___ <br /> <br />,) Per~on 10 c:onlact n::~garding this application, if dit)~rcnt n'om <:ibovc: <br /> <br />Narne Cldxk Eur"t,id:2>2' <br /> <br />Posi tlonfTiltc_nYe ~i ~L~ r (: ~'mAlli~J_Y_::O>_~mmm <br /> <br />Address_~Q_~_~~:;s__.LtQ_Q!~.~.m~_l:_~.LJLI ____~}AJ_~~]::_.QJ2.~L?m_nm_n <br /> <br />Busjnes~ Phonc NlH11bc[' (-2.QlL5._;/~~::}2_~}_n <br /> <br />I{orne Phone 'l.....'urnber( 801")52!-}.nJ5B2 <br /> <br />c-rnail !\ddress_ burb:idf::':.e(}~.~.<~v~~.t )1,ov nUn_mm_ <br /> <br />3. Type ororg8niz~nion (Ditch Co,~ lrrig:1tion D~st6ct. Jvhmicipality. etc.) _,.Eg_(tf;:r.~.1._ a.~reT:i;~V <br /> <br />Date of AnnuCll1'\'1eeirng ...Ji.L:\... <br /> <br />Is the ol'lmnization incorporated in the SU,te of'Colomdo? YES <br /> <br />p){)u:::", (rfYES, picase <br /> <br />include a copy of the articks of in cor pur at ion, and the byhnvs \vith this ;..1pplic:ation forD),) <br /> <br />( '~"l "~qn~~ <br />