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wR.l•5-zz - <br />Application must <br />'~e complete where <br />applicable. Type or <br />print in BLACK <br />K. No overstri kes <br />erasures unless <br />initialed. <br />( )OTHER <br />RECEIYED~ <br />DEC 8 '72 <br />•~it :. <br />(1) APPLICANT -mailing address <br />NAME Ernestine T. S Billy W. Daugherty <br />STREET 1475 South Birch <br />CITY Denver. Colorado 80222 <br />(seatel t2~c1 <br />TELEPHONE N0. 756-9641 <br />(2) LOCATION OF PROPOSED WELL <br />County Las Animas <br />SW ~, of the NE '/., Section 30 <br />Twp. 33 So., Rng. 68 W 6th p,M <br />131 WATER USE AND WELL DATA <br />oposed maximum pumping rate (gpm) <br />~erage annual amount of ground water <br />to be appropriated (acre-feet): <br />12 <br />Number of acres to be irrigated: None <br />Proposed total depth (feed: 50 Feet <br />Aquifer ground water is to be obtained from <br />Stonewall Alluvial <br />Owner's well designation $1 <br />GROUND WATER TO BE USED FOR: <br />(~ HOUSEHOLD USE ONLY - no irrigation (0) <br />( 1 DOMESTIC 11) ( )INDUSTRIAL 151 <br />( 1 LIVESTOCK 121 ( )IRRIGATION (61 <br />( 1 COMMERCIAL (4) ( 1 MUNICIPAL (el <br />( )OTHER (91 <br />14) DRILLER <br />'game /z"~/'iU~V ~, S/V~r~~h <br />treet ~~ ~~~ ~ `~ <br />G'/ (State) (ZIDI <br />Telephone No. L}' 6 - ~ / ~~ Lic. No. ~ 7 <br />COLORADO DIVISION OF WATER RESOURCES <br />101 Columbine Bldg., 1845 Sherman St., Denver, Colorado 80203 <br />PERMIT APPLICATION FORM <br />QIXI A PERMIT TO USE GROUND WATER <br />~1 A PERMIT TO CONSTRUCT A WELL <br />FOR: QIX) A PERMIT TO INSTALL A PUMP <br />( )REPLACEMENT FOR N0. <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />Receipt No. X97 79 / <br />Basin <br />Dist. <br />CONDITIONS OF APPROVAL <br />This well shall be used in such a way as to cause <br />no material injury to existing water rights. The <br />issuance of the permit does not assure the applicant <br />that no injury will occur to another vested water <br />right or preclude another owner of a vested water <br />right from seeking relief in a civil court action. <br />ADDrwed }or household use only, tar one (1) single tamiy dwelling and rot to <br />be used for irrigation. The return Ilow from the usa of this well roust !b <br />teNmed to Ne same stream rystem In which the well is lopted. <br />BED /~~~/~7z- <br />A~~ <br />C'c~ /y33Y"7-A <br />APPLICATION APPROVED <br />PERMIT NUMBER <br />66950 <br />DATE ISSUED DEC 2 2 ~m <br />EXPIRATION DATE _f1EC 22 1974 <br />•\ <br />T EN EER) <br />BY <br />l.D. COUNTY <br />