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r <br /> COLORADO DIVISION OF WATER RESOURCES 011we Use Only Farm(WS48 PIgi <br /> DEPARTMENT OP NATURAL RESOURCES <br /> 1313 SHERMAN ST,RM 018,DENVER CO 80303 RECEIVED <br /> phmre—Mfo:(no)858�87 malts M ON-Mi <br /> Fa7G 88MR89 MWJWwyaW.$1eWftm <br /> MONITORING/OBSERVATION DEC 012011 <br /> Water Well Permit Application �2 <br /> Rsvlawlaslruoltoleantevomeldeprlortoeolnpteftfonn. WSTA E ENGINEERS <br /> The(oft must be Dom eted In bleak or bbre Ink or typed. COLO. <br /> 1.We"Owner Information 6.Use Of Well <br /> rime. «ew <br /> Uae of this well Is limited to monitoring water levels _ <br /> and/or water quality sampling <br /> 7.Well Data(propo� <br /> W 500 laws.R ouj I BLED YGWNP --------- — — <br /> P%oft ago " <br /> , ASO 154-2-3(a S.Consultant Information of applicaMe) <br /> FOWWOR HaMOFO nactpemm <br /> 2.Type Of Aeplication(check appllc8bIs boxes) r n_ <br /> ❑use eoaaurre,yeu O Reptaaemom foreoAdurg rrrordtoru►g.wdl: --�r-yya� l l l� _ _ _ <br /> 0 01her uq tlewtve0 Pmmoc R n❑t)ther. P�l f+ <br /> 3.Rofer To 0 applicable) � 120coftf <br /> «�_. VJDO ill lAt�rlJ LD soLLL <br /> {�{. T�eptnne A <br /> 4.Location Of Proposed Well(lmportantl Sao Instructions) <br /> MOW CDP, 8.Proposed Well Driller License lions <br /> rudau _ us 10. t$nature Of Well Owner Or Authorized Agent <br /> semen Ton « t'cr a�n The f fates etebeiiienffi herein conatikdea perltgy br are eeaonci <br /> �+ �� i+ e/ wh Is purheb as a aloes t ndederlmanor punurant to GR.S <br /> 243 71V 1 4 , 1 h RN efatdRobts h0 M.know the contents <br /> mdometmue n"ObarMsOwAmb".08 r FFNIA pane" <br /> atiuetomykttOwfel�0._ <br /> .11,rV1 f o.WNEIS Fn 0EN(w feel dlrealton /r.�1`•f�� ! � , - -_ { 1 <br /> NkebceaaneQdreseQnda�eCfq smart cmaceaw9eaaauroama.aai:' Office Use Only �l�► <br /> Yaua�tNtealcOPa;salttoitequdned ssafrtgeae fo8owa: <br /> FaanetaaitesUYAI 3aOG _�_� Rooatpl area Doty <br /> ft*o mire t2«d mne ra a n •pQ nl 1. <br /> tlArreestbAldaTaie ,"11 <br /> WUiotrmarbeaAoee mw*92Je1A4z L. <br /> u»lewtbeeutbtwaaoAh <br /> W0W$wa srabR 4 OVO itemernbarws WHAM NEr SW <br /> 6.Property Owner htfSrmation <br /> ranee Properpraaaer is :t2$1<oT.H <br /> lreT+saaaeo <br /> �$5�_ ' ��Id►" ''fr8rtsmctyorrS------------9653434--------.._.. <br /> Date: 1211R011 2:39:54 PM <br /> ras ern* 20006 Transee lon Total: $100.00 <br /> Vu . W �i ��t t CHECK#1172 $100.00 <br /> Td*hbdee 1LJlrf3�A/.� pW I WD_�V_ BA—Up_� <br />