PROJ01829

• Contract/PO #: C153749
• Contractor Name: DeWeese-Dye Ditch and Reservoir Company
• Contract Type: Loan
• Water District: 12
• County: Custer
• Loan Projects - Doc Type: Application

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RECEIVED
MAR 18' 196

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Colorado Water Conservation Board
Pre-Application Form for Construction Fund Loan

This form is intended for pre-application purposes to provide the Colorado Water Conservation
Board (CWCB) staff with some preliminary information regarding a proposed water project and
the project sponsor. This form may also be used to apply for a feasibility study loan from the
CWCB.

When completing this pre-application, please type or print with black ink. You may attach
additional pages, maps, drawings, etc. which you feel would be helpful in describing your project
or explaining your water supply problem. If you have questions about this form or about the
application process, please call the Project Planning and Construction Seclion of the CWCB at
telephone number [phone].

A different loan application from accompanied by a feasibility study must be submitted when
actually applying to the Board for a loan. See the Guidelines for Financial Assistance through
the Colorado Water Construction Board Fund for a copy of the full loan application form and
instructions for conducting the feasibility study.

Generally, the loan applicant is also the prospective owner or sponsor of the project. If this is
not the case, please provide an explanation.

1. Name and address of applicant:
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Telephone number: (7/7) 2>'75. g4~S'

2. Person to contact regarding this application:
Name: (ft.-IFF /ZE-]JJ
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3. Type of organization (ditch company, irrigation district, municipality, special district,
private owner, etc.): :[) ; Ie II Q 72C;SOZWliL C,OI2..,!lt:J.I:{4nc;.t/

4. Please provide a brief description of existing water supply facilities and describe any
. existing operational or maintenance problems (attach separate sheets and a map if needed):
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