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GR)G im. Z <br /> WRJ•s•Rev. 76 COLORADO DIVISION OF WATER RESOURCES <br /> 818 Centennial Bldg., 1313 Sherman St.,Denver,Colorado 80203 <br /> PERMIT APPLICATION FORM <br /> Application mus ^^EtVE� <br /> bi complete where�EC �1 ( )A PERMIT TO USE GRO <br /> applicable. Type or QQ (Y)A PERMIT TO CONS <br /> print in BLACK Alp 2 4 19%OR: (Y)A PERMIT TO INSTA <br /> OW <br /> INK.No overstrikes ccCCP a Q <br /> or erasures unless WATER RWWRM ( ) REPLACEMENT FOR U IM <br /> initialed. so.U41110 ( )OTHER <br /> I& WATER COURT CASE <br /> (1) APPLICANT- mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br /> NAME By'ettt Affla"oMi! L_ $Cll Receipt No. d / <br /> STREET P.e.Box ext Basin Dist. <br /> CITY tale Sp,cfn!JS --(s11; - 8Z1p � CQNDITIONS OF APPROVAL <br /> TELEPHONE NO. C&J) (aU_/70Z This well shall be used in such a way as to cause Ex pvA <br /> no material injury to existing water rights. The <br /> (2) LOCATION OF PROPOSED]I FELL issuance of the permit does not assure the applicant '3vt't:K. <br /> that no injury will occur to another vested water Rk <br /> right or preclude another owner of a vested water <br /> County YAp I ree right from seeking relief in a civil court action. <br /> % of the S E '/.,Section 32- ISSUANCE OF THIS PERMIT DOES NOT <br /> Twp. � ', Rng, P.M. 1) APPROVED PURSUANT TO CRS 37-92-602(3z�b)&II) <br /> IN.S) (E•W) (AA)) AS THE ONLY WELL ON A RESIDENTIAL SlTlE F <br /> (3) WATER USE AND WELL DATA APPRUXIMATBLY 9 ACRES DESCRIBED AS THAT PORTION <br /> OF THE N 1/2 OF THB NE 1/4 OF THE SE 1/4 OF <br /> SECTION 32 T3S R72K OF THE 6TH P.M., CLEAR <br /> Proposed maximum pumping rate(gpm) 1� CRREE COUN�'Y HIM MOM PARTICULARLY DESCRIBED <br /> ON THE ATTAC>'#RD EXHIBIT "AAmM <br /> . <br /> Average annual amount of ground water "�^ 2)) THE USE OF GROUND WATER FROM THIS WELL IS <br /> to be appropriated (acre-feet): LIMITED TO ORDINARY HOUSEHOLDPURPOSES INSIDE A <br /> SINGLE FAMILY DWELLING AND WATERING OF THE <br /> Number of acres to be irrigated: D USER'S NONCOMMERCIAL DOMESTIC ANIMALS. THE <br /> GROUND WATER SHALL NOT BE USED FOR IRRIGATION <br /> ProWsed total depth (feet): 60 OR OTHER PURPOSES. <br /> Aquifer ground water is to be obtained from: 3 g9W A1604j►A `'DISPOSAL <br /> SYSTEM OF THE NON-9 TIVB TYPE WHERE THE <br /> WATER IS RETURNED TO THE SAME STREAM SYSTEM IN <br /> Owner's well designation SMI - <br /> WHICH THE WELL IS LOCATED.y� _ "g.2/86 <br /> TH � 1 <br /> GROUND WATER TO BE USED FOR: <br /> (X) HOUSEHOLD USE ONLY-no irrigation (0) <br /> { ) DOMESTIC (1) ( ) INDUSTRIAL (5) <br /> ( ) LIVESTOCK (2) ( } IRRIGATION (6) <br /> { ) COMMERCIAL (4) ( ) MUNICIPAL (8) <br /> ( ) OTHER (9) APPLICATION APPROVED <br /> DETAIL THE USE ON BACK IN (11) 2 5` 447 <br /> PERMIT NUMBER <br /> (4) DRI_ LLER ��cENs ED DATE ISSUED SEP 2 2 1911 <br /> Name EXPIRATION DATE SEP 2 2 1990 <br /> Street 6( , /V`aov,;� <br /> City ST TE ENGIN ) <br /> (state) ( 151 <br /> BY <br /> Telephone No. Lic, No. <br /> I.D. t" ��• - COUNTY -•y---• -Z-�• <br />