2015-01-29_HYDROLOGY - M2002020

• Permit No: M2002020
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/29/2015
• Doc Name: Rodman Well Pumping Information
• From: Law Office of Gilbert Y. Marchand, JR., P.C.
• To: DRMS
• Email Name: PSH
• Media Type: d
• Archive: No

COLORADO DNISION OF WATER RESOURCES ��
Office Use Only Form GWS-45 (1/2001)
DEPARTMENT OF NATURAL RESOURCES
R�CE`�EO —
1313 SHERMAN ST., RM 818, DENVER, CO 80203
phone -Info: [phone] train: (303) 866 -3581
fax: [phone] htt : //www.water.stata.co.us
pit
Ins 1
0
GENERAL PURPOSE
WK „n,;
Water Well Permit Application
gS"L�`
Review instructions on reverse side prior to completing form.
The form must be completed in black It *-
1. Applicant Information
6. Use Of Well (check applicable boxes)
Name of apPacm
Attach a detailed description of uses applied for.
- L -1-- -= — O DA-?,+Al — ----
j] Industrial ❑ Other (describe }:
Q Municipal
Mailing address
/� ��j�.��'
"7 �O
�� -�
ode
Chi � - slat�� zip 4 j - --
7J /
;krigation
❑ Commercial
Telephone s//••�� _r } Z..��
( / ✓!
7. Well Data (proposed)
`
2. Type Of A plicatlon (check applicable boxes)
Maximum ptunPing rate
._
~Tt
Annual amount to be withdrawn
/ acre -feet
❑ Constroct new well ❑ Use existing well '
AquNot
❑ Replace existing well ❑ Change or increase use
_ - feet
,Change source (aquiferj ❑ Reapplication (expired permit)
S. Land On Which Ground Water Wig Be Used
Other:
3. Refer To (if
A. Legal Description Imey be provided as an attacnme":
applicable)
ter._
j (r�� ,,,�� cS.' -� •t7
Ilf used for crop imi atian, attach a acaled mao that shows it ted ares.F
Wall permit A
water Court case A
designated Basin Determinstion A
!j
well name or A
AA114
4. Location Of Proposed Web
County
�'
S. A Acres C. owner
1!4 of the .!^.�' 714
Section
Township I__t
Range ❑ Princisai MerWien
l/v
O. Lin enY otter ovals or water rights used on this land;
Distance of well from section lines Oman lines are typically not prop" Onesi
S
iS -p Fr from ❑ N s �/ ij Ft irem� E Cj W
9. Proposed Well Driller License #(o tional).
trot reptaeentettt walls only - 463tance and Wraccbn from ofd well to now well
10. Signature Of App6eant(s) Or Authorized Agent
feet
The making of false statements herein constitutes perjury in the second
degree, which is punishable as a class 1 misdemeanor pursuant to
_direction
Well location ante" pf applicablW
C.R.S. 24- 4104113)la). I have read the statements herein, know the
contents thereof and state that they are true LO my knowledge.
Optional: GPS well location Information in tnM format
sign here (tiers` be *FWAd signature)
r `
Data
Required settings for GPS units are as follows:
Fom+at must be Urm
Zane must bat3
Northing
oaae a ntlo
Units must be Memrs
Daavn mt:st bs NAD27 1CONU31
Ming
Office Use Only
Unit mast its set to mn north
Were points averaged? []YES ❑ No
USGS rnmP name
OWR map fit. Surface elev.
S. Parcel On Which Well Wal Be Located
A. Legal Description `may be provided as an ehmencl:
n area o
+ Receipt H
° "'g 7 t Inveice 0 474626
16016a VT 12$84 35 6 66 LTii1[i 8 O!
C&B Ot BW 316.1S't1 OF = COR 111128111:4
4/11/81 — 3324:42 PH
N851K2•M 544.361 X00015.2 49S.474 TO
Cashier I17: 81
8 R/N LN 87211122I N $75.5411 TO 1111 COR
$68.0
OF TPA= IM =586 P0473 8324 ° 01 • TO
81sO (5.2" KA)
Check Purchase- 84253
WE
B. a of acres in parcel
C. owner
y
wR
cwce
D. Will this be the only web on this parcal7 YES >3K fit no - an other welts(
...- —
TOPO
MYLAR
5. state f>arcal too loptionaq:
1
ses DN 1 VM BA MD