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<br />- - -- <br />Well Use Infonnation <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />- <br /> <br />Please complete the following application in its entirety to provide sufficient information for the well augmentation plan. Those applications not filled out entirely will be <br />rejected and sent back for completion. <br /> <br />~~llt~f'I~:.~I~~~~,e; :~lt~tlfi'~t~tl~' x~~~:~' <br /> <br />ACRES :'i::';, <br />IRRIGATED'. <br />~ii?s;,; <br /> <br />HOW MUCH!;AWN,i:" HOWMANY,1I0MES .:. <br />DOESTHEWA'lliRi.i', DOESTHEwATER; <br />FROM THIS WI!l.LOO::' FROM nllS wELL 00 <br />'rO?(INSQ:F'f.) . ':; TO?' ... <" <br /> <br />I <br /> <br />"KEY: Irrigation Method: (F) flood, (S) sprinkler, (N/A) Not Applicable <br />Well Use: (I) irrigation, (D) domestic/Iivestock, (H) household, (M) municipal, (C) commercial <br />Sole Source (yes or no) if no mark the ditch company and shares used with each well. <br /> <br />Have you purchased or leased any water from sources other than AGUA ? <br /> <br />If yes, where and how much? <br /> <br />Southeastern Colorado Water Conservancy District Application Questions. This information must be filled out: <br />. How many acres of Irrigable Land (Irrigation land only) do you own or operate? Owned and/or Leased ? <br />. Have you alrea<tr completed an RRA certification form this year for the Conservancy District? yes no <br />. If no, check one below and you may receive an application in the mail if you own 240 or more acres and return to AGUA as soon as possible. <br />. Are you a sole owner (spouse included)? Is the land owned or leased through any type of legal entity? Corporation_, Trust_, Estate_. or <br />Partnership_. Please mark one. <br /> <br />PageJ of4 <br />