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DEC-05-2000 08 53 R~X PROS P.03i10 <br />___„~- <br />I~EJ.49•]5 <br />TrPE DR <br />VgINT IN aI ACK INK <br />COPT OF nCCEP~ <br />STATEMENT MgILED <br />ON REOUFST. <br />COLORADO DIVISION OF WATER RESOURCES <br />' 818 Centrnrtial Bldg., 1313 Sherman St. <br />Denver, Colorado PA103 <br />STATE OF COLORADO <br />COUNTY OF <br />} S5. <br />.~_ STATErnENT OF BENEFICIAL USE OF <br />AMENDMENT OF EXISTING RECORD <br />_~_ LATE REGISTRATION <br />WATER <br />PERMIT NUMBER ~ 13;, ~! - <br />THE AFFIANT(S)_ Albert R. Ford and Duels W. Ford <br />whose morl'rng <br />address Is Route ~ B:~x 019 <br />City _ _~EZt~r~~2 39_22.2,-..- <br />I<r. •rr rr <br />ce~~r, <br />AFFIDAVIT <br />r=~1- <br />LOCATION OF WELL <br />~~_/. of rl,< NE_~_ ~. src rlurr 17 <br />T., p. 2 <br />being duly sworn upon oath, deposes and says Ilwl he (they} is (arc) the owner(s) of <br />ocared as described above, at distances of _ 80Q feet from the North <br />r.ov._ o• avv..l <br />Wash section line; water from this we}I was first applied ro a beneficial use for th <br />day of ~3}r 19 ,QQ_; -lye maximum sustained pumping rate of the well is <br />ate claimed hereby is ..315-_ yrtllons per minute; the coral depth of the well is <br />f water to be diverted is _- _ ncre-feel for which claim is hereby made for <br />purpose(s), the legal description of the land on <br />q„y. 67 _ W 6th P N <br />rE oc ni <br />well described hereon; the well is <br />ion line and 2600 feet from tltc <br />poses} described herein on the 1S <br />gallons par minute, the pumping <br />feet; the overage annual amount <br />h nc~ worst from Ihis well Ix used is <br />of which <br />acres arc irrigated and which is illustrated on the map on the reverse side of thi ;form; that this well was completed in <br />amplionce with the permit approved therefor; this statement of beneficial use of ground stet is filed in compliance with law; he <br />hey) has (have) read the statements made hereon; knows the content thereof; and that th same are true of Itis (choir) knowledge. <br />(COMPLETE REVERSE SIDE OF THIS FORMI <br />gnoture(s) ._~.._. __.. .. <br />b scribed and sworn <br />before me on this day of _ 19 <br />c=~. <br />y Commission expire t: ,., <br />yr.u Pno, <br />.~. r.v. us ur D. ., <br />,CEPTED FOR FILING BY THE STa TE ENGINEER OF COLORApO <br />1~SU,~ NT TO THE FOLLOWING CONDITIONS: s°r~-- <br />CEPTED FOR FILING <br />THE OFFICE OF w<il u.< <br />~; STATE ENGINEER <br />CORDING TO THE D.. r. _ <br />REE CHANTED UNDER <br />EH DSYISION_ <br />tiUANT TO SECTIO~~ <br />=2-304 (O), C8S <br />FOR OFF IC;E USE ONLr <br />Na. W-4547 Well 411 <br />Me. _~ DaI ___ Y.. _. <br />n rr.-. <br />1__ gp.,„ Mar. D.: _~-. <br />i <br />