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NRJ-5-P.ev^16 COLORADO DIVISION OF WATER RESOURCES <br /> 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado-80203 <br /> b <br /> t PERMIT APPLICATION FORM ��`'r�VL <br /> Application must <br /> he complete where I ) A PERMIT TO USE GROUND WATER I <br /> applicable. Type or (X ) A PERMIT TO CONSTRUCT A WELL r.,1 04 92 <br /> print in BLACK FOR: ( ] A PERMIT TO INSTALL A PUMP <br /> INK.No overstrikes h..,L,;, <br /> or erasures unless ( ) REPLACEMENT FOR NO. STATEtti�Kd(�� <br /> initialed. ( } OTHER <br /> WATER COURT CASE NO. ) <br /> (1) APPLICANT - mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br /> COTTER CORPORATION <br /> NAME Receipt No. 6. <br /> 12596 West Bayaud Avenue, STE 350 <br /> STREET Basin Dist. � <br /> Lakewood CO 80228 <br /> CITY (state) (zip) CONDITIONS OF APPROVAL J <br /> TELEPHONE NO. (303) 980-1292 This well shall be used in such a way as to cause V <br /> no material injury to existing water rights. The <br /> (2) LOCATION OF PROPOSED WELL issuance of the permit does not assure the applicant C� <br /> that no injury will occur to another vested water ! <br /> JEFFERSON right or preclude another owner of a vested water T <br /> County right from seeking relief in a civil court action. <br /> NW of the SE '/a,Section 25 O <br /> Twp. 2 S. Rng. 71 W 6th P.M. <br /> ,N,51 ,E.Wi <br /> (3) WATER USE AND WELL DATA <br /> Proposed maximum pumping rate (gpm) N/A <br /> Average annual amount of ground water N/A <br /> to be appropriated (acre-feet): <br /> Number of acres to be irrigated: N/A <br /> Proposed total depth (feet): 22.5 ' <br /> Aquifer ground water is to be obtained from: <br /> Surface Alluvium - Ralston Creek <br /> Owner's well designation IOW-2 <br /> GROUND WATER TO BE USED FOR: <br /> ( ) HOUSEHOLD USE ONLY -no irrigation (0) <br /> { ) DOMESTIC (1) ( } INDUSTRIAL (5) <br /> ( I LIVESTOCK (2) ( } IRRIGATION (6) <br /> ( }COMMERCIAL (a) ( ) MUNICIPAL (8) <br /> ( 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 /> (State) !zip) <br /> Telephone No. <br /> (303) 980-1292Lic. No. <br /> NIA BY <br /> l.D. COUNTY -34 O <br />