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COLORADO DIVISION OF WATER RESOURCES 3S <br /> 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203 <br /> PERMIT APPLICATION FORM `1 <br /> Application must _'EIn1i:0 <br /> be compete where { } A PERMIT TO USE GROUND WATER <br /> applicable. Type or {X ) A PERMIT TO CONSTRUCT A WELL AMR , <br /> print in BLACK FOR: I ) A PERMIT TO INSTALL A PUMP I'�+rt ��q� <br /> INK.No overstrikes <br /> or erasures unless ( ) REPLACEMENT FOR NO.initialed, OTHER( ) OTHER _ fA7EE1 <br /> t <br /> WATER COURT CASE NO. <br /> aJ w <br /> (1) APPLICANT. mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN2 <br /> COTTER. CORPORATION �,3,�Q? o~ <br /> NAMEReceipt No. / <br /> Co <br /> STREET 12596 West Bayaud Avenue, STE 350 Basin Dist. I <br /> Lakewood CO 80228 CA <br /> CITY (state) (Zip) CONDITIONS OF APPROVAL <br /> CD <br /> TELEPHONE N0. <br /> (303) 980-1292 This well shall be used in such a way as to cause 1 <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 X of the SE Section 25 <br /> j Twp. 2 _S, Rng. 71 W 6th P.M. <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-feed: <br /> Number of acres to be irrigated: N/A <br /> Proposed total depth (feet): 25.5' <br /> Aquifer ground water is to be obtained from: <br /> Surface Alluvium - Ralston Creek <br /> Owner's well designation MW-1 <br /> GROUND WATER TO BE USED FOR: <br /> ( ) HOUSEHOLD USE ONLY -no irrigation (0) <br /> ( } DOMESTIC (1) ( ) INDUSTRIAL (5) <br /> t ) LIVESTOCK (2) ( ) IRRIGATION (6) <br /> { ) COMMERCIAL (4) ( ) MUNICIPAL (6) <br /> ( X) OTHER (9) Mcinitgring 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 /> (Slate) (ZIP) <br /> Telephone No. <br /> (303) 980-1292 Ll.c. No. N/A BY <br /> I.D. COUNTYc3 O ef <br />