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n <br /> , ii MAga— : VTir <br /> •Form . Rev.)' STATE OF COLORADO .'3...?_ 1 <br /> '7=�i8/° APPLICATION FOR USE OF GROUND WATER s#19'1 1 <br /> (Use Indelible Pencil or Typewriter) WATER sEct <br /> LQiE11D0 <br /> Applicant D.e 1 b e Tr AI Sumo h ,‘ �CATION OF W FI� AD° <br /> County pin 2(71._ <br /> P.O. Address i i <br /> Quantity applied for 7 gpm or 9 v 1,g s. L^-S Sect. 3 , Twp. <br /> _, ,i,,,p A Storage <br /> - Age.' /D fi l P.M. OR <br /> Used for :,� Purposes <br /> on/at Street Address or Lot & Block No., <br /> (legal description of land'site) _ .�.,_ , <br /> Town or Subdivision <br /> Total acreage irrigated and other rte. <br /> ESTIMATED DATA OF WELL N <br /> ) Role size: 7 in.to yA ft.' f <br /> in,to ft. <br /> _r --- - <br /> Casing Plain 7 in, from�to ft. I - <br /> 1 Locate <br /> in.,from to ft. I well in <br /> Perf `in. from 30 to u o ft. a 40 acre <br /> in. from to ft. - . IIIIIIINIIIII 0 8 (small) <br /> PUMP Outlet , square <br /> DATA: Type • .HP.Sized ....r_ as near <br /> � +_ - as possible. <br /> • Use initiation II1,te <br /> (Use Supplemental pages fot additional data) • <br /> $25.00 fee required for Industrial, <br /> THIS APPLICATION APPROVED Commercial or Irrigation uses. <br /> NO. 9711 Applicants -#t''1 pl i c -tn.- <br /> Agent or <br /> DATE SEP 19 Agent argot No..�? ''. <br /> • Address 4 <br /> ' 1. NOTE—SATISFACTORY COMPLETION REQUIRED FOR APPROVAL OF APPLICATION <br />