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wRJ425.70 STATE OF COLORADO <br /> Index No. DIVISION OF WATER RESOURCES Zg293p <br /> IDWD OFFICE OF THE STATE E INEER-V ��6zi 4 �R� <br /> s ��ld MAP AND STATEMENT FOR WATER WELL FILING ti NOVfdNOV 19 1971 <br /> 71 Checked By RECEIED <br /> PERMIT NUMBER_ 47329 r WATER RESOURCES <br /> No SLATE ENGINEER <br /> STATE OF COLORADO ) SS WELL LOCATIONf 8�«31501"��2� <br /> CLAIMANT (s)__ Harold A Simpson <br /> Clear Creek / ounty <br /> 3367 So. Wolff Street Deriver, Colo 80236 NE y, of Sw '/ sec. 33 <br /> being duly sworn upon oath deposes and says that he (they) Is (are) <br /> the owner(s) of the well described hereon; the total number of acres T. 3S R. 72W 6th P.M. <br /> of land irrigated from this well is None _ <br /> work was commenced on this wel I by actual construction on the INDICATE WELL LOCATION ON DIAGRAM <br /> 15 day of Sept 19-71; the sustained NORTH <br /> I I I <br /> yield from said well is gpm, for which claim is hereby made I I I <br /> I <br /> + <br /> for Domeetj C', purpose (s); --- <br /> I I <br /> the average annual amount to be diverted is N. A. w ___ I _ I D J <br /> acre-feet; this map and statement is filed in compliance with law; 3 I j r m <br /> he (they) has (have) read the statements made hereon; knows the I I <br /> content thereof; and that the same are true of his (their) own <br /> knowledge. I l I <br /> Signature(s) <br /> SOUTH <br /> Address: Jr <br /> 7 <br /> WELL SHALL BE LOCATED WITH REFERENCE TO <br /> GOVERNMENT SURVEY CORNERS OR MONUMENTS, <br /> S scribed and s0arn to before me on this day OR SECTION LINES BY DISTANCE AND BEARING. <br /> of 19_L_�L___ N, x• --ft. from N.A. section line. <br /> ,�j (North or South) <br /> My Commission expires:. a�- <br /> (Seal) N. A. ft. from N. A. section line. <br /> (East or West) <br /> Notary Public <br /> Ground Water Basin N. A. <br /> Water Management <br /> WELL DATA District <br /> Date Completed ;L pP­tnmha,- 1; _ 1971 Domestic wells may be located by the following: <br /> Static Water Level. 21-1 LOT N. A. -, BLOCK N. A. <br /> Total Depth of Well 501 SUBDIVISION X_ A_ <br /> FILING 4_ N_ A- <br /> ACCEPTED FOR FILING IN THE OFFICE OF THE STATE ENGINEER OF COLORADO ON THIS DAY <br /> OF . 19 <br /> STATE ENGINEER <br /> FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM must be an original copy on both sides,and,signed. <br /> WHITE AND GREEN copies must be filed with the State Engineer within 30 days after the well is completed or within 7 days <br /> after expiration date of the permit. whichever is sooner: PINK rnPY is for the Owner and YFI I Ow COPY is for the Driller. <br />