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i :: 1313 SFiERMAN ST., RM. 818, DENVER CO 80203 <br />phone -info: 1303) 866-3587 r :13031866-3581 <br />GENERAL PURPOSE <br />h ~r L~ '~/ GC~Y~~ ~. <br />~ater Weti Permit Application <br />r~~.n'=T ~~ ,....~,...~^.., .,r.~,9...e o. „..,. III VI I I <br />Review instrucyons riot to eompletin form ) I II IIII III ..._...._....,.---°-•• - D--~ - --• -- ----- - -- <br />Must be com Isted in blsck ink or sd <br />APPLICANT INFORMATION <br />1 YELL please attach detailed description) <br />. ggy <br />"^"•'°'"`•'" CK7 INDUSTRIAL ^ OTHER: <br /> ^COMMEFCIAL <br />R.ANKLIN CONSOLIDATED PIINING,INC. ^ MUNICIPAL <br />""'"'• "°•r•'• ^ IRRIGATION <br />B ~ ^FEED LOT-number of heal: <br />,0. $0$ 3B <br /> 7. WELL DATA <br />Cirr seta fir CWa Mulrnen aen%na rata .V..r .rna\wt <br /> qpm acrofeat <br />DAHO SPRINGS, COLO. 80452 Tad YON AeJlr <br />Tiaebna numeOr Iiicl W a ar0, e W al f eeL <br />303-567-4288 8. LAND ON WHICH GROUND WATER WILL BE USED <br />2. TYPE OF APPLICATION (check applicable box(es)) A• LEGAL DESCRIPTION Imay be provided ,a ,n ,n,chrtwntl: <br />D Construct new well D Use existing well P,ANCE 72 WEST SECTION 12 <br />^ Replace existing well D Change or Increase Use <br /> <br />^ Change (source) Aquifer ^ Reapplication I.•pirca a.rmitl TOWNSHIP 1 NORTH <br />C9 Other UI uwd Ior crop irrigation, rR,ch neded map that .hews ir.ip eba an,,l <br />3. REFER TO (if applicable): g• ~ ••^' c• oW"•r <br />Wrar court cse I Pam+i[ r <br /> 0. Lbt ,ny other walla or w,Lr dghb Iraad an tNr I,nd: <br />Emeryrncy Verb,I 7 Monitoring hek ,cknowladgmant <br />-VE- MH- - <br />vv.ll ^,mr or r 9. PROPOSED WELL DRILLER (optiona)l <br />' Nana tiae~a tint <br /> ,~ <br />t4. LOCATION OF WELL <br />f:ounry u,rter/qurrter <br />yU` SgovWW.rtar 10. SIGNATURE of applieantls) or authorized a ent <br />BOULDER , <br />I~UARTER +/, t)UARTER/, The making of false statements herein constitutes perjury <br />:faction Tewnhip Not 5 Range E or W Prirciyl Maridrn in the second degree, which is punishable as a class 1 mi5• <br />12 1 ~ ^ 7 2 ^ m 6th demeanor pursuant to C.R.S. 24-4.104I13)(al• I have read <br />oia.na. of w.n from .nation cons the statements herein, know the contents thereof, and state <br />n from ^ N D S ~ ~ n tram ^ E ^ w that they are true to my knowledge, <br />'Mi badon Waru., II d^armt hqn Oreliamt Ware. 01 appirOtlal Mut M rVln/.prutvra ' <br /> ~~ <br />9145 SUNSHINE CANYON DRIVE, BOULDER, CO. T;aa tl... <br /> <br />f.. r.r...m.nt r.a. aNt - a.e•K..,d ~.«aen loam ar...r t. ~....n g n e r a I mgr . ~ G <br />feet direction OPTIONAL INFORMATION <br />5. TRACT ON WHICH WELL WILL BE LOCATED uses m.r n.m. Owltmy ro. sua.aa .«. <br />A. LEGAL DE6eRIPTIDN Im,y be provided re an ,n,chmentl: <br /> Office Uee Only <br /> DIV <br /> CO <br />B. STATE PARCEL <br />IDI (aptlen,l): WD <br />C. r new i\ tn\n D. lhrnr <br /> BA <br />E. Will this be the only well on this tract? <br />l~ YES ^ IVO (! other wells ere on [hrs irect, nee detailed inst.! USE1S) MD <br />Form GuiS-35 (12/95) <br />