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'OVRJ-5•Pe•, 76 COLORADO DIVISION OF WATER RESOURCES <br /> -'k 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203 / <br /> PERMIT APPLICATION FORM ��� ,`f -� <br /> Application must <br /> be complete where I I A PERMIT TO USE GROUND WATER "S <br /> applicable. Type or {X } A PERMIT TO CONSTRUCT A WELL WR 0 -�2 ` <br /> print in BLACK FOR: ( I A PERMIT TO INSTALL A PUMP a <br /> INK.No overstrik..s <br /> or erasures unless ( } REPLACEMENT FOR NO. WATER R:;]d)RCES <br /> initialed. ( IOTHER ^,ti0 � <br /> WATER COURT CASE NO. <br /> (1) APPLICANT. mailing address FOR OFFICE USE ONLY: 00 NOT WRITE IN THIS COLUMN <br /> 2 r r a,NAME COTTER CORPORATION Receipt No 3�b 0d <br /> STREET 12596 West Bayaud Avenue, STE 350 gash Dist. <br /> CITY Lakewood CO 80228 <br /> (state) (Zip) CONDITIONS OF APPROVAL. <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 /> (t) 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 y4 of the SE va,Section 25 <br /> Twp. 2 S. 8ng. 71 W 6th P.M. <br /> W.SI iE•W1 , <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): 15.0 1 <br /> Aquifer ground water is to be obtained from: <br /> Surface Alluvium - Ralston Creek <br /> Owner's well designation MW-3A <br /> GROUND WATER TO BE USED FOR: <br /> { ) HOUSEHOLD USE ONLY • no irrigation (0) <br /> { ) DOMESTIC (li ( ) INDUSTRIAL (5) <br /> ( ) LIVESTOCK (2) ( ) IRRIGATION ,6) <br /> ( I COMMERCIAL (4) ( ) MUNICIPAL (81 <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 /> Istate) (Zip) <br /> Telephone Na. <br /> (303) 980-1292 Ll.c. No. N/A BY <br /> I.D. f COUNTY -30 d / <br />