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Receipt No.3650573A WELL PERMIT NUMBER 285909 Page 2 <br /> ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT <br /> CONDITIONS OF APPROVAL <br /> NOTE:This permit will expire on the expiration date unless the well is constructed by that date.A Well Construction and <br /> Test Report(GWS-31)must be submitted to the Division of Water Resources to verify the well has been constructed.An <br /> extension of the expiration date may be available.Contact the DWR for additional information or refer to the extension <br /> request form(GWS-64)available at:http://www.water.state.co.us/pubs/forms.asp <br />