2020-06-25_REVISION - C1981035 (34)

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WRJ•25.72 _ COLORADO DIVISION OF WATER RESOURCES THIS Ff ._mjS'r BE SUBM TTED PRIOR TO 101 Columbine Bldg., 1845 Sherman St. THE EXPIRATION OF THE PERMIT.TYPE OR Denver, Colorado 80203 PRINT IN BLACK INK. STATEMENT OF BENEFICIAL USE OF GROUND WATER �3 _AMENDMENT OF EXISTING RECORD PERMIT NUMBER 49203 STATE OF COLORADO ,ry COUNTY OF LA PLATA SS. 1NSSA1 ....URGES ENGMEER gTAT r'flLU. THE AFFIANT(S) William L. Watts attorney for Diana G. La William L. Watts, P. 0. Box 1117, Durango, Colorado 81301 whose address is Diana G. Lapp,_ The Lapp Ranch, P. 0. Box 307, Mancos, Colorado 81328 attorney for the being duly sworn upon oath, deposes and says that he (&a) is/ the owner(* of the well described hereon; the well is located in the NE 1/4 of the IOW 1/4 of Section 11 Township 35 North (N. or S.) Range 12 West N.M. P.M. at distances of 200 feet from the North section line (E. or W.) (North or South) and 2,649 feet from the East section line; the total depth of the well is 400 feet; water from this well (East or West) was first applied to a beneficial use for the purpose(s) described herein on the 10th .day of November 1.9_ 71 ; the maximum sustained pumping rate of the well is 15 gallons per minute, the pumping rate claimed Hereby is 15 gallons per minute; the average annual amount of water to be diverted is 24.1.9 acre-feet; for which claim is hereby made for agricultural _..� purpose(s); the legal description of the land on which the water from this well is to be used is NNW of Section 11 and NE of Section 10 T 35 N. R 11 W (Portion of acreage is uphill from well and not: cultivatable) which totals 120 acres/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 statements made hereon; knows the content thereof; and that the same are true of his (their) knowledge. The original map and statement signed by Merle Holgate and acknowledged Decem- ber 21, 1971, is in error, and such error is agreed to by Merle Holgate. Signature(s) Wi in L. at Subscribed and sworn to before me on this lath day of FOR OFFICE USE ONLY �_'+'IaSr 19 72 , Prior. Date , , I9 My Commisslon,evpi.res: October 16, 1975. Well Use (Seal) �p// Notar Public ACCEPTED FOR FILING IN THE OFFICE OF THE STATE ENGINEER OF T. _" R. P.M. COLORADO ON THIS DAY OF---, 19 Yield _ W.D. Co. STATE ENGINEER Index WHITE COPY FOR DIVISION OF WATER RESOURCES PINK COPY FOR WELL OWNER