Laserfiche WebLink
— ' ----1 <br /> COLORADO DIVISION OF WATER RESOURCES — _— _. <br /> For ottiEe / <br /> f orm No, DEPARTMENT OF NATURAL RESOURCES <br /> ovoroermitsonlineca state cc us <br /> CHANGE IN OWNER NAME/MAILING ADDRESS <br /> �o mm�p�nwm���� �s/w�oono�own���muc <br /> mcompue/c. '"=~ =^ov.on/LLsmeLe --`nC^mwOroepnocsmmsuuwnw/LLaaxs/onmso <br /> _ <br /> v |'� '� <br /> | Namein>: La-Plata-County Lowd,LLC-___ <br /> | waionnAuuo�^ 13742W 59th-Aye- <br /> 0tysxan, <br /> prj«»« i3}8—}�t�_'���' �n�/ | <br /> Well Permit Number: 287129 Receipt NL;mt,-w.r 3652885 Case NumberWELL LOCATION <br /> | <br /> County- La __ _ Well Name m#lovm � �� <br /> one � �____ <br /> Street Aadres,,dt Weli Location City Slate Zip <br /> [I Chw*if well address is same as uwner s mailing address <br /> I(we)claini and say that I aw(we are)ffie owner(s)of the well perruit described above,kn(YN the contents of the slaternerAs madp�,Prttin, <br /> and state trial!,iey a,e true to my(our knowtedige rt)isfiiitigis,iadepLirsuanttoCRS 37-90-143 <br /> Signature(s,) the,NeW CJA(ne r tt,e Signer's Narne Title Date <br /> /Zo <br /> —lit,,the 4j�T-,,bhtyTf the newowner of Ihis well permit to completreand sign this form If an agent is signing or entering info,mation please, <br /> . ammy*"uiuns <br /> Pli-u�oo/m°^ms weeks t'vm;mvovign/m'xfonn T/�e,naftv.you ov`vie~o/print the accepted mxumien\at . <br /> ��u������ <br /> ' -----' m[»VR,u#f'`o"camnaccepw'neana Change'n Owner Name o^om'Mailing Address \ <br /> For Stunuo"on, i <br /> | ----'— — Date | <br /> !!-t a <br /> | ~�r '__ <br /> � <br />