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WELL PERMIT NUMBER 25144-F-R RECEIPT NUMBER 3669507 <br /> NOTE:This permit will expire on the expiration date unless the well is constructed and a pump is installed by that date. A Well <br /> Construction and Test Report (GWS-31)and Pump Installation and Test Report (GWS-32) must be submitted to the Division of <br /> Water Resources to verify the well has been constructed and the pump has been installed. A one-time extension of the <br /> expiration date may be available. Contact the DWR for additional information or refer to the extension request form (GWS-64) <br /> available at: http://www.water.state.co.us <br /> Date Issued: 5/28/2015 <br /> Issued By SARAH BRUCKER Expiration Date: 5/28/2016 <br /> PERMIT HISTORY <br /> 01-31-2020 PERMIT AMENDMENT(CONDITIONS) <br /> Printed 01-31.2020 For questions about this permit call 303.866.3581 or go to www.water.state.co.us Page 2 of 2 <br />