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COLORADO DIVISION OF WATER RESOURCES (� <br /> - 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203 <br /> PERMIT APPLICATION FORM_ r� '1 <br /> Application must Ye�� «{�� <br /> be complete where { 1 A PERMIT TO USE GROUND WATER {y <br /> applicable. Type or {X ) A PERMIT TO CONSTRUCT A WELL pp \ec <br /> print in BLACK FOR: ( ) A PERMIT TO INSTALL A PUMP <br /> INK.No overstrikes or erasures unless ( I REPLACEMENT FOR NO. ti+� <br /> initialed, ( )OTHER PO�G; EFIR <br /> WATER COURT CASE NO. y� V <br /> a1 to <br /> (1) APPLICANT - mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN' <br /> NAME COTTER CORPORATION Receipt No..?3p04!F / <br /> 12596 West Bayaud Avenue, STE 350 <br /> STREET Basin Dist. _E <br /> CITY Lakewood CO 80228 a' <br /> (state) (Zip) CONDITIONS OF APPROVAL J. <br /> 13 <br /> TELEPHONE NO. (303) 980-1292 This well shall be used in such a way as to cause <br /> no material injury to existing water rights. The <br /> (2) LOCATION OF PROPOSED WELL issuance of the permit does not assure the applicant <br /> that no injury will occur to another vested water <br /> JEFFERSON right or preclude another owner of a vested water <br /> County right from seeking relief in a civil court action. <br /> NW SE 25 <br /> y, of the /., Section <br /> j Twp. 2 _S, Rng. 71 W 6th P.M. <br /> ;N.$) tE.w, <br /> (3) WATER USE AND WELL DATA <br /> Proposed maximum pumping rate (gpm) N/A <br /> Average annual amount of ground water NSA <br /> to be appropriated (acre-Feet): <br /> Number of acres to be irrigated: N/A <br /> Proposed total depth (feetl: 25.5t <br /> Aquifer ground water is to be obtained from: <br /> Surface Alluvium - Ralston Creek <br /> Owner's weiI designation MW-1 <br /> GROUND WATER TO 5E USED FOR: <br /> ( } HOUSEHOLD USE ONLY - no irrigation (0) <br /> ( } DOMESTIC (1) ( ) INDUSTRIAL (5) <br /> ( ) LIVESTOCK (2) ( I IRRIGATION (6) <br /> ( ) COMMERCIAL (4) ( ) MUNICIPAL (8) <br /> I X) OTHER (9) Monitoring Well APPLICATION APPROVED <br /> DETAIL THE USE ON BACK IN (11) <br /> PERMIT NUMBER <br /> (4) DRILLER <br /> DATE ISSUED <br /> Name COTTER CORPORATION EXPIRATION DATE <br /> Street 12596 West Bayaud Avenue, STE 350 <br /> City Lakewood CO 80228 (STATE ENGINEER) <br /> (statel (ZIP) <br /> Telephone No. (303) 980-1292Lic. No. N/A BY <br /> I.D. COUNTY 0 <br />