2015-11-18_PERMIT FILE - M2015033

• Permit No: M2015033
• IBM Index Class Name: PERMIT FILE
• Doc Date: 11/18/2015
• Doc Name: Adequacy Reply
• From: Varra Companies, Inc.
• To: DRMS
• Email Name: PSH
• Email Name: WHE
• Media Type: D
• Archive: No

INSTRUCTIONS CHANGE OWNERSHIP -ADDRESS LOCATION CORRECTION FORM JULY 1993
NO FEE IS REQUIRED
The form must be typewritten or printed in BLACK INK. Initial and date any changes you make on the form.
THIS FORM MAY BE REPRODUCED BY PHOTOCOPYING OR WORD PROCESSING MEANS.
INCOMPLETE FORMS WILL BE RETURNED. ATTACH ADDITIONAL SHEETS IF MORE SPACE IS NEEDED.
•
1. Print the new owner's name and include the mailing address and phone number.
2. Indicate if the change in ownership/address is for a well permit, livestock water tank or erosion control
dam. Be sure to include the proper permit, tank or dam number.
3. Complete the well location information. If the address of the well location is different than the mailing
address of the owner, include the address where the well is located. If the owner has more than one
well, provide well name or number as designated by the owner; i.e. North Well, The actual well location
must include 1/4,1/41 Section, Township and Range. Check the appropriate boxes for North or South and
East or West directions. Complete the Subdivision, Lot, Block and Filing information, if applicable,
4. Complete the location information for the livestock water tank or erosion control dam. The actual
location must include 1/4, Section, Township, Range and P.M. Check the appropriate boxes for North or
South and East or West directions.
5. Check the reason(s) for submitting the form, whether it is a change in ownership/address and/or location
correction.
6. The owner of the structure must sign. Print or type your name in the first block if it is different from Item
No.1. If signing as a representative of a company who owns the structure, then your title must also be
Included in the first block. Sign the second block and date the last block.
USE THIS FORM TO CORRECT THE LOCATION OF YOUR WELL IF:
A. Your well was permitted, registered, or first used prior to May 8, 1972 for ordinary household
purposes in up to three single-family dwellings, fire protection, the watering of poultry, domestic animals,
and livestock on farms and ranches and the irrigation of not over one acre of home gardens and lawns.
B. Your well is not of the type described in A above, but was permitted or registered prior to May 17,
1965. Inside the Designated Ground Water Basins, other procedures and publication may be required.
C. Your well was. decreed by thy; Water Court for the correct location,
IN ALL OTHER CASES USE FORM GWS -42
All other types of changes concerning Livestock Water Tanks and Erosion Control Dams should be submitted
on the standard Permit Amort form and be accompanied by a $15.00 fling fee.
If you have questions, contact the Denver or the Division Office where your well is located.
DIVISION 1
8008thAve Rm321
Greeley CO 80631
[phone]
DIVISION 5 Box 396
50833 US Hwy 6 & 24
Ginwd Spgs CO 81801
945-5665
DIVISION 2 Box 5728
219W5th Rm223
Pueblo CO 81003
[phone]
DMSION 6 Box 773450
625 So. Lincoln Ave
Stmbt Spgs co 80477
[phone]
DIVISION 3 Box 269
422 4th St
Alamosa CO 81101
[phone]
DIVISION 7 Box 1880
1474 Main St
Durango CO 81302
[phone]
DIVISION 4 Box 456
1540 E Niagara
Montrose CO 81402
[phone]
DENVER OFFICE ..
Rm 821.
1313 Sherman St
Denver CO 80203
[phone]