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Form No. OFFICE OF THE STATE ENGINEER <br />GWS -25 COLORADO DIVISION OF WATER RESOURCES <br />818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br />(303) 866-3581 <br />APPLICANT <br />MARIA DE LOURDES PALMA <br />1007 E 24TH STREET RD <br />GREELEY, CO 80631-9090 <br />(970) 302-0190 <br />ZIr] <br />LR <br />WELL PERMIT NUMBER 297435 <br />DIV. 1 WD 3 DES. BASIN MD <br />Lot: 3 blocK: 1 -fling: Subdiv: LUNDGREN <br />APPROVED WELL LOCATION <br />WELD COUNTY <br />NW 1/4 NW 1/4 Section 4 <br />Township 5 N Range 65 W Sixth P.M. <br />DISTANCES FROM SECTION LINES <br />1200 Ft. from North Section Line <br />64 Ft. from West Section Line <br />UTM COORDINATES (Meters, Zone: 13,NAD83) <br />cdsuny. <br />Norning: <br />ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT <br />CONDITIONS OF APPROVAL <br />1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of this permit <br />does not ensure that no injury will occur to another vested water right or preclude another owner of a vested water right from <br />seeking relief in a civil court action. <br />2) Construction details for this existing well have not been provided to this office; therefore, it is not known if the construction <br />of this well is in compliance with the Water Well Construction Rules, 2 CCR 402-2. The issuance of this permit does not <br />relieve the well owner of responsibility or liability in the event contamination of the groundwater source results from the <br />construction or use of this well, nor does the State Engineer assume any responsibility or liability should contamination <br />occur. <br />3) This well is recorded and permit approved in accordance with CRS 37-92-602(5) for historical use as indicated herein <br />and described in CRS 37-92-602(1)(b), being a well producing 15 GPM and used for ordinary household purposes inside 1 <br />single family dwelling(s), fire protection, the watering of domestic animals and poultry, and the irrigation of not more than <br />538 square feet of home gardens and lawns. <br />4) The date of first beneficial use, as claimed by the applicant, is January 1, 1925. <br />APPROVED <br />SMJ \ <br />State Engineer By <br />Receipt No._3669291 DATE ISSUED 04-30-2015 EXPIRA IO D E t t'I <br />