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1/�4/93 SOUTHERN HIGH PLAINS PERMIT INFORMATION SHEET <br /> : . <br /> Permit No, <br /> OWNER Priority Date Div .r'G <br /> Use �r�4a/?]JiDi] Co C�5 <br /> ADDFt. �Y//o`�5, t Qd le d-J 7 Depth wD �O <br /> Aquifer MD /Q <br /> Meter Required? [3 Yes B No DR 3 <br /> PHONE (h) Expanded A.? ❑Yes,ue bellow ❑No Grp <br /> (M Commingling7 ❑Yea, see below ❑No <br /> WELL LOCATION (0,C 1/4 114,Section ,3� ,Township a30 �, Range 'S� west <br /> feet from the section line, feet from the section Hne. <br /> PERMrr STATISTICS Acre-feWyear, G.P.M., /doe Acres <br /> Description of irrigated scree: - / <br /> -r <br /> Date Completed,sate l@suad Beneficial Use expiration date 7 ,Action Code � f��S�•��`'�-S� <br /> Assoclalbed permits and notes <br /> Q <br /> Initials Date <br /> EXPANDED ACRES Priottty Dade The priority is the date of❑Appilcatbn ❑Fist Use ❑Other <br /> Aorerfaet/yssr, Additional Acres, Acres Total Description of❑Additional Acne ❑Total Acres: <br /> Initial@ Date <br /> CQMMINGUNG Commingled Permits <br /> Acre-fe"ear, Acne Deecxiption of krl &W sores: <br /> _ Initials Data <br /> FINAL PERMIT EVALUATION CHECKLIST OFFICE USE <br /> ❑Evaluated Initials Date Checked: Initials Date <br /> ❑SBU received Date Reasons:❑not required,or If❑required,then❑reosived <br /> ❑Clari6ad I.W.I. Date Checked:Initials Date <br /> 0D %entered InRWs, - Date �WVerM*d: Initials Date <br /> ❑Final Permit Fee received Receipt No- <br /> Final Permit Issued Data <br />