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COLORADO DIVISION WATER RESOURCES Office UseIt Qn} <br /> DEPARTMENT OF NATURAL RESOURCES Form GWS-45(07/2013) <br /> 1313 SHERMAN ST,RK211,DENVER,CO 80203Main303 866-3581 Fa 8W-2223 dwr ermit onlin , fa at>GENERAL PUOSEtAAAJZ 1 t3 Z()tu <br /> Water Well Pet Application irdlTLai RESOUR06'0Review Instructions on r side prior to completing form, S"fitt'E ENGINEEF: <br /> The form must be compu erigeneratQd,typed or In black or blue ink. Cr)L C) <br /> 1.Applicant Informa !on <br /> 6.Use Of Well(check applicable boxes <br /> Attach a detailed description of uses applied for <br /> ❑ Industrial ❑ Dewatenng System <br /> ❑ Municipal ❑ Geothermal(production or reinjection <br /> state ' z:pcode "- --�--�- �----- ❑ Irrigation <br /> A � d ��„�O ❑ Commercial <br /> ® Other(describe) WELL POND EVAP <br /> ele -e rea Cads 8 M/ r) 11 E.mml(online 6uig rwru,rK, 7.Well Data (proposed) <br /> 70 _ Ma cmum punp ny rate Arrual amount to ba witnorawn <br /> .Type Of Applicatio check applicable boxes) gpm <br /> ❑Construct new well Use existing well Total o°prr 14 5 acre-feet <br /> (� - <br /> ❑Replace existing wlsli ❑ Change or increase use 10 <br /> ❑Change source(aquifer) feet Aqua; <br /> ❑COGCC Well ❑ Reapplication(expired permit}Other. Pena S. Land On Which Ground Water Will Be Used <br /> . , <br /> 3.Refer To(if applica le Legal Description of Land(�ay be provided as an eeacnrrcnl) <br /> �- - <br /> i <br /> De5!gnatod Basin Delamrnabon R l WPII nano or• - <br /> South Pond <br /> 4.Location Of Proposed Well <br /> Archuleta NE u4 0l the $W 1ya (If used for crop irrigaton,attach a staled maP that shows irrigated area) <br /> A X Acres- _- - Q, Onror Seaon T Townsh p CIO S Range E or N Pnna <br /> 25 poi Mend an <br /> �kL.�C I f._I 12 ❑ El tNM <br /> aslence of weit hem te-4on Inogs lse on hires are f call-not e l$,any atner v a is«ws:er rxjhts I.%ad on INS lane <br /> 1P Y INopany I,nasj <br /> L L�Vr •a"\'] Fi from } Ft frorrlE ]W <br /> FOr ropla-cefianiiQwe`Iiii«ny-a�slanCa 1,7treCil«l frombrdwPI1 to <br /> r@.v�woIi -' 9.Proposed Well Driller License#o tionat <br /> feel direction 10.Sign or Entered Name Of Applicant(s)Or Authorized Agent <br /> Well locafton address(Include Coy St a k-p) Clock d AeN add, is svna as in Item I The making of false statements herein constitutes r'u in the second <br /> ❑ 9 pe} N. <br /> degree,which is punishable as a class 1 misdemeanor pursuant to C R S <br /> 2010 COUNTY ROAD 5 0,PAGOSA SPRINGS CO 81147 24-4-104(13)(a). I have read the statements herein,know the contents <br /> -- there state that they ar true to my knowledge <br /> Optional: GP$well Beaton info aeon in UTM format You must check GPS unit for Sin ante, ame(s)of person( .,b ling application yyyy> <br /> required settings as follows Data Im rvdd y) <br /> F must be UTM <br /> (-i zonZone1Y«!f"I Zone 1J s�g�ng mtrameaha'u/ <br /> Uri is ays!be Meters <br /> Datum must beNAD87 ± NorthingKA <br /> tart must be se:et to we iwnn ffi S@ 0111y <br /> was CPS aril checked for abore')❑rEs l Remambor to set Datum to NAD83 USG3 ray came l DWR map rw 3 rfa;x Ne, <br /> 5.Parcel On Which W II Will Be Located <br /> (PLEASE ATTACH A CU RI tENT DEED FOR THE SUBJECT PARCEL) Re <br /> cipt area only <br /> A. Legal Description Imay be oraeo as an a!tachmenq r <br /> C <br /> f`' T ry r't/Ie�-> ✓�'r'v,, ,+ ( ,r r r�0 L 1 C <br /> -f � �car 5.. C ,J= I g= ' `�� 1� r °. ✓ a=, <br /> i - AVA . 3(00°Sag 3-g <br /> B. it of acres n paroa 1 C Owner AOUAMo ;�� <br /> 394 MASK LLC hE Nr't-, > t' <br /> -i_-- ' <br /> D. Nfll thus be the ur Aall on Ih,s ce1� — wR <br /> Y' ®YES MQ IA no l�sr ntra�wet s} <br /> CN>'C6 <br /> ADDITIONAL WELL POND]APPLICATION TOFp <br /> It State Parcel II'.tf rcyboral) MYLAR ^^G <br /> 569925200005 $05 Div WD d 1 BA. _ MD <br /> A C/r�./n r rt RT <br /> _77—S pvfcc -t CaScr C raob e cJ 1 C)i . <br /> Nra,s�«w.4 idn. N-1483.0ao <br /> iC,,X A-PPif rtoAeAL /htX*0 L ure Ia./31 S <br />