2020-06-25_REVISION - C1981035 (34)

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WrJ-25-7Z, F\ECEI V F COLORADO DIVISION OF WATER RESOURCES AUG 23 1889. T)-PE OR 818 Centennial Bldg., 1313 Sherman St. PRINT IN BLACK INK- RMI COPY OF ACCEPTED Denver, Colorado 80203 amaENGlNM STATEMENT MAILED Will ON REQUEST. STATE OF COLORADO AFFIDAVIT COUNTY OF SS. STATEMENT OF BENEFICIAL USE OF GROUND W!iER _ AMENDMENT OF EXISTING RECORD J. .; LATE REGISTRATION SS- 43 , PERMIT NUMBER _ LOCATION OF:; WELL THE AFFIANT(S) 0( y S r Lc� _ ('ou ly - g1 whose mailing - ?� fV address is of the %.. sect City _ s x Twp- - {aI ATrS 17IPV being duly sworn upon oath, deposes and says that he (they) is (are) the owsier(s) of the well described hereon; the welt is located as described above, at distances of -_� 740 d feet from the re f section line and 26ao feet from the I NOR T 1. , -III-u N:5 section line; water from this well was first applied to a beneficial use for the purpose(s) described herein on the _ W I.F AST OP W F 7 T 1 day of "4I_ 19.z�7 the maximum sustained pumping rote of the well is -I-i-61—gallons per minute, the pumping rate claimed hereby is /d_. gallons per minute; the total depth of the well is �--feet, the overage annual amount of water to be diverted is acre-feet; for which claim is hereby made for l. r t1yP� $`/6G/r purpose(s); the legal description of the land on which the water from this well is used is _S412 me a S cr I /e. — --- ---� o f which acres are irrigated and which is illustrated on the map on the reverse side of this form; that this well was completed in compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he (they) has (have) read the st ments made hereon; knows the content thereof; and that the some are true of his (their) knowledge. ET VERSE SIDE OF THIS FORM) Signature(s) d�9 —� �.- Subscribed and sworn FOR OFFICE USE ONLY to before me on this day of 19 Court Case No. My Commission expires: _ r5t A.- Prior, ------- Mo. __ Day .._-._ Yr .T T - NO'ARY t"JS L I C Div. r7 Cty, ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO PURSUANT TT�OO� THE yttFOLLOWING cc CONDITIONS: y, oo rr TT sec —-,- 'i'. - --..-.. .- ��. -, A. llZiSiiSl_ �S}:! - !l- Y- T-� .�.I -E48_�ld Well Use - 1) IN ACCORDANCE VITN CRS 31-92-6824) FOR NISTORIC USE AS INDICATED DELON. AN DESCRIDED IN CIS 31-92-60d2t1)(D). D,st" ...� nus,n Man. D., _ -�-- 2) A HELL PRODUCING 10 GALLONS PER NINUTE AND USE) FOR THE YATERING OF LIYESTOU ON A FAN OR AMU. AUG 2 E D A T ST TE E NEER RY