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DEC-05-2000 08153 R X PROS <br />TTPE OR <br />PRINT IN el'n~K INK <br />DOPY OF etCEPTED <br />$7~iEME NT MAI~EO <br />ON REOUF57. <br />COL4RAD~DIVISION OF WATER RESC~)U•fS <br />818 Centennial Bldg., 1313 Sherman St, <br />Denxer, Colorado 80203 <br />STATE OF COLORADO <br />COUNTY OF <br />SS. <br />__. STATEMENT OF BENEFICIAL USE OF GROUN:) WATER <br />^_ AMENDMENT OF EXISTING RECORD <br />_XX- LATE REGISTRATION <br />PERµITNUMBER_ ~~~~~ <br />THE AFFIANT(S) _ A1hezY R" Ford ,& nrrPl,ja W, Cord _____ cP~«I, <br />whose moiling <br />address .s 17 pylto lr RsyY O]_Q_„_ _ ~~1 <br />iiiiiiiiiiiiiiiiiii <br />sss <br />7~ ~~ V' <br />AFFIDAVIT <br />LOCATION OF W[LL <br />'/, of rl,.. NW %. Scc r:o,. ~,7 <br />City ._, -.11CLLV.B:Gr~.D_.80~9--.. ___..._, 7~P. _ _.S- Rn9~ .-6.L.. ~_ ~Y.~.hP w <br />y•..rl inrl ;•N of sr c u. «~ <br />being duly sworn upon oath, deposes and says that he (they) is (ore) the owner(s) of:the well described hereon; the well is <br />located os desr,rlbed abase, ar di sconces of _ 660_ feet from the «rnNolthrr• scktion line and 1325 _ toot from the <br />West srctiorl line; water from this well was first applied to o beneficial use for th{: purpose(s) described herein on the 31 <br />«... e. -... I <br />day of Deceml)eL 19 30 ; the maximum sustained pumping rate of the well is <br />rote claimed hereby is _315 _ oallons per minute; the total depth of she well is <br />of water ro be di vetted is acre-fort; for which clni:n is hereby mode For <br />purpose(s); the legal dcsuiprion cf the land on <br />315 gallons per minute, the pumping <br />feet; the o~erogc annual amount <br />iGh the water from this well is used is <br />of which <br />acres are irrigated and which is illustrated on the map on the rexarse side of tft is form; that this well was completed in <br />compliance with the permit approved therefor; this statement of belteiicial use of ground iratar is filed in compliance with low; he <br />(they) has (have) read the statements made hereon; knows the content thereof; and that t le same ore true of his (their) knowledge.. <br />(COMPLETE REVERSE SIDE OF THIS FORM) <br />ignature( s) <br />subscribed and sworn <br />o before me on this day of <br />iy Commission expires; <br />i:r.a <br />FOR OFFICE USE ONLY <br />19 _ <br />co~rr c ~,. Nn. W-4597 Well 112 <br />•pr•~r rue SIG <br />.CCEPTED FORyyFEEILFINpG BY THE STATE ENGINEER OF COLORADO <br />CCEPTED FOR FILIFOLLOwING CONDITIONS: <br />Y THE OFFICE OF t1G <br />8E STATE ENGINEER <br />CCORDING TO TFfE <br />,CREE GRANTED UtiDER -, fi <br />95E N0._-(~(l~~7-2- <br />,TER DIVISION / , <br />FtSUdNT TO SECTION <br />r-92-306 (8), C8S <br />~E-7GlAY 3 0 1984 Sinie-ENGINEER ~-~`--"'-~~- <br />Prior <br />Di ., <br />se... <br />weu <br />D~sr. <br />- - '.. <br />eo:~~ - <br />Mo. ~ Da, _-_ Yr. -_ <br />G,,. ~-~ <br />_ .. :. <br />Man. O.s _ <br />