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COLORADO <br /> ON OF WATER <br /> DEPARTMENT OFINATURAL RESOURCES RESOURCES Office Use Only RECEI GWS-45(0 2013) <br /> 1313 SHERMAN ST,RM 821,DENVER,CO $0203 <br /> Main: 303 SW3581 Fax 303 886 2223 dwriaermitsonline0state.co <br /> GENERAL PURPOSE MAR 11 Z01 <br /> Water Well Permit Application VVATER RESOu ES <br /> Review Instructions on reverse side prior to completing form. STATE ENG I ER <br /> The form must be computer generated,typed or In black or blue Ink. COLD <br /> 1.Applicant Information _ _— _ 6.Use Of Well(check applicable axes <br /> Name of appiwnl _-- <br /> Attach a detailed description of uses a lied for. <br /> GP Irrigated Farms LLC CIO Karl Nyquist ® Industrial ❑ Dewa ng System <br /> ►riming address <br /> 7991 Shaffer Pkwy Suite 200 ❑Municipal ❑ of production or reinjection <br /> stale —- ,�__.. _.. Irrigation 7e±d <br /> eel(describe):oil&gas exploration <br /> Llttleton CO 181027 Ctxrxrtercial <br /> Telephone a(area oxe a nufter) E-rrwl(orrine Wig rewred) 7.Well Data(Prof ) <br /> 303-369-5100 amy@cacompanies.com Lqumumpunongrats Annual arnptntt0oawnncri»n <br /> 2.Type Of Application(check applicable boxes) 9Prr' !B,1 acre-feet <br /> ❑Construct new well ® Use existing well <br /> ❑Replace existing well ❑ change or increase use feet <br /> ®Change source(aquifer) 0 Reapplication(expired permll) 8.Land/On Which Ground Water Will Be Used <br /> COGCC Well Other. - - ----— -- --3.Refer To(if applicable) - <br /> Legal D cription of Land(nay be provided as an aluchment). <br /> _ <br /> wed pwmt x �- Waw Court ate a <br /> 4231-F 12CW37 SWSP ID 5389 <br /> Designated Basin bownwasoon is ——I Well nanr a it - — <br /> 1 Lamar Farms#5 <br /> 4.Location Of Proposed Well <br /> (if used for crop krlpation,attach a scaled map that arrows Irrigated area.) <br /> Prowers I NE tleoftl,e NW t)+ A. sAcm B. owner — <br /> SecSon To%WWNP Nor SS rRange E or W I Finn pp-1 <br /> 33 ,22 CI 1 ( 46 ❑it 116 C. tut any oth V wens or water n"used on Tft tared: <br /> Dis-- tafto VAN kon secim inw(Namlitnes we"Cady not Property�) -- <br /> Ft.bom(-N r--S FL E❑W <br /> mstance and di�,fromold,,ellto now WAM _— — - 9.Proposed Well Driller License o tional : <br /> feet direction 10.Sign or Entered Name Of Applicants)Or Authorized Agent <br /> 1NN location snldrua Itipludi Giy;stw ap) ❑distil--- aaar as In awn t - The making of false statements herein constitutes periury In the second - <br /> degree,which is punishable as a class 1 misdemeanor pursuant to C-R-S. <br /> 24-4-104(13Xa). i have read the statements herein,know the contents <br /> thereof _stale that they are true my knowledge. <br /> optional: GPs wet location adormawn in UTM bum Y must deck GPS unit for 1 a pint(:)iij n m plasm Oala lmmodhrrr) <br /> reed sevings atl(atlows: 77 3 <br /> Fomet wont be UTU ---- <br /> tl pmt and"a <br /> wets OvAt t to UUitar 13 Ea 711463 ` v <br /> Data must be Ao.s hang 4219432 Office Use On <br /> urw crust be set to trw north ---- - ..Was GPS tarsi d,eaed to above? YES USGS en"fwm - — DWR map no, Surface We` <br /> ❑ Ram wdw to set Datum to NA053 <br /> S.Parcel On Which Well WI Be Located --- - — - <br /> (PLEASE ATTACH A CURREN DEED FOR THE SUBJECT PARCEL) Receipt area only fed <br /> A. Legal Description(may be pr s sn aearseI"): `--_—-- , Gv Gt 5ll C1/j�/� e <br /> �Tff0 ZZ015 <br /> I <br /> T_— ..._ . .- -- — — ADUAKW <br /> taa.r <br /> WE Transaction#: 3668741,9 <br /> --- i -- - --- WR data: 3111ri015 9:$6:24 AM <br /> D. V1Wft;bs arrv» onmsp- w? QYESE]Notilnoistorw-aft)r � Transaction Taal: 3700.00 <br /> TOM CREDIT GARD g7o0.00 <br /> E. tlta4 uDsfaosarwY <br /> sBS DiV_ WD 61 eA—ME)— <br />