Laserfiche WebLink
' WRJ~S•Rev. 16 <br />Application must <br />ba complete where <br />applicable. Type or <br />'print in BLACK <br />I N K. No overstri kes <br />or erasures unless <br />'initialed. <br />(1) AI <br />'NAME <br />COLORADO DIVISION OF WATER RESOURCES <br />818 Centennial Bldp., 1313 Sherman St., Danvsr, Colorado 80203 <br />PERMIT APPLICATION FORM <br />(}{ 1 A PERMIT TO USE GROUND WATER <br />( ) A PERMIT TO CONSTRUCT A WELL <br />FOR: ( ) A PERMIT TO INSTALL A PUMP <br />1 <br />1 <br />ng address <br />C.O.M. inc /J.tJ.TATMAN <br />'STREET ~~/I~ $()LSSHT~rg f'ANY(~N <br />CITY Ar1Tli T1FR CO. Rf1'i02 <br />Isue.l tzrol <br />.TELEPHONENO.- 303-449-7746 <br />(2) LOCATION OF PROPOSED WELL <br />BOULDER <br />County <br />~'W '/. of the SE '/., Section 12 <br />~wp. IN _, Rng, 72 W W P.M. <br />IN,51 <br />I E. WI <br />,(3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate Igpml <br />~verage annual amount of ground water <br />o be appropriated lacre•feetl: <br />50 <br />7.5 <br />umber of acres to be irrigated: none <br />~oposed total depth Ifeatl: 250 <br />quifer ground water is to be obtained from: <br />FOUR MILE CREEK ( Se3t~a~~ie~ap ) <br />oar's well designation MINE SHAFT <br />ROUND WATER TO BE USED FOR: <br />I HOUSEHOLD USE ONLY no irrigation 101 <br />1 DOMESTIC (11 ( ;Q INDUSTRIAL 151 <br />1 LIVESTOCK 121 ( I IRRIGATION (61 <br />I COMMERCIApL (4) ( )MUNICIPAL 181 <br />' ~i DETOL'SFIE~ROON B8a~~53~~T~r~'~~~R~aib4 <br />,4) DRILLER <br />CASH MINE PATENT ~b 68 <br />Name PRE-E`CISTING MITE SHAFT <br />~treet <br />CI ry <br />(Statat ( .p) <br />Sri ~elephone No. Lic. No. <br />)REPLACEMENT FOR NO <br />(OTHER <br />WATER COURT CASE NO <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br /> <br />FEB 2 0'92 <br />COLO. <br />Receipt Na. / <br />Basin Dist, - l~~ <br />. '.r: <br />CONDITIONS OF APPROVAL :~ <br />This well shall be used in such a way as to cause <br />no material injury to existing water rights. The <br />issuance of the permit does not assure the applicant <br />that no injury will occur to another vested water <br />right or preclude another owner of a vested water <br />right from seeking relief in a civil court action. <br />APPLICATION APPROVED <br />PERMIT NUMBER <br />DATE ISSUED <br />EXPIRATION DATE <br /> <br />(STATE ENGINEER( E,~ / 1 .~( ~/ <br />BY '1 /D~ ~ ~, <br />I.D. COUNTY <br />