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~~ -~^ <br /> , COLC '.DO DIVISION OF WATER RESOURC F(~y~IVED <br /> _ <br />wR...ze . <br /> 818 Center,.,~al Bldg., 1313 Sherman St., Denver, Colorado 80:03 <br /> <br /> P RMIT APPLICATION FORM <br /> gpplicaLOn must -' ~ Y~. <br /> tie complete where <br /> <br />pplicabte. Type or , ^ ~ PERAtiT TO USE GROUND WATER <br />` <br />(~ 1 A PERMIT TO CONSTRUCT A WELL n4_`= <br />= ,,,. ~ <br />_.1~ 'r' <br /> ~ <br />print ~n BL J <br />R: ( ) A PERMIT TO INSTALL A PUh1P <br />~t <br />( ` <br />~ B 2~.!l:'_? <br /> ~ <br />! <br /> or erasure u I ° f I REP LA CE AIENT FOR N0. _ r,?.~1= <br /> initialed. ( I OTHER L _~ `ID <br /> WATER COURT CASE N0. `~_ `_I_ <br /> <br /> <br />1 <br />(1) APPLICANT -mailing address <br />NAME Gold Hi 11. Ventures <br />FOR OFFICE USE ONL <br />CL-1 <br />Receipt No. ~a / <br />N4T WRt <br />.r;~ <br />7A+^"~ <br />c~~ <br />STREET PO Box 1523 ~ Basin <br />CITY Lon mont, CO 80501 <br />(soul IZ~oI <br />TELEPHONE N0. 449-774 <br />I' (2) LOCATION OF PROPOSED WELL <br />County Boulder <br />SE '/, of the NW '!., Section 12 <br />Twp. 1 I] Rng. 72 i9 6th P.M <br />^ iN.51 IE.WI <br />(3) WATER USE AND WELL DATA <br />' posed maximum pumping rate Igpm) Samples on1V <br />Average annual amount of ground water <br />o be appropriated lacre~feet)~ D <br />lumber Oi acres to be irrigated: D <br />~roposed total depth Ifeet): <br />quifer ground water Is to be obtained from: <br />Granite <br />•vner's well designation * 2 <br />GROUND WATER TO BE USED FOR: <br />1 HOUSEHOLD USE ONLY ~ no irrigation (0) <br />DOMESTIC ltl ( 1 INDUSTRIAL 15) <br />( )LIVESTOCK (ZI ( 1 IflRIGAT10N i6) <br />~I COMMERCIAL ldl 1 1 MUNICIPAL 18) <br />107HER (91 MOni ri?~ <br />DETAIL THE USE ON BACK IN 111) <br />DRILLER <br />^ e GROUND ScATER SYSTEAiS. INC. <br />4599 N. Broadteav <br />Boulder CO 80302 <br />t5i.i., IZ~oI <br />0 ~ st. <br />~[~, I'_1 <br />IN THIS COLUMN <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 />APPROVED PURSUANT TO C.R.S. 37-90-137(2) TO <br />TISFY THE PERMIT REQUIREMENTS OF C.R.S. <br />-9D-138(3). USE OF THIS WF,LL IS LIMITED TO <br />NITORING WATER LEVELS AND/OR WATER QUALITY <br />THIS WELL MUST BE EQUIPPED WITH A LOCKING <br />P OR SEAL TO PREVENT WELL CONTAMINATION OR <br />SSIBLE HAZARDS AS AN OPEN WELL. THE WELL <br />ST BE KEPT LOCKED AT ALL TIMES EXCEPT DURING <br />MPLING OR MEASURING. <br />RECORDS OF WATER LEVEL MEASUREMENTS AND <br />TER QUALITY ANALYSES SHALL BE MAINTAINED BY <br />E_WELL_OWNER_AND SUBMITTED TO THE DIVISION OF <br />SION OF 'f HE MONITORING PROGRAM, <br />SHALL PLUG AND ABANDON THIS WELL <br />WITH THF, RULES AND REGULATIONS <br />RSONSTRUCTION AND PUMP INSTALLA- <br />HALL MARK THE WELL IN A CONSPICU- <br />APPROPRIATE WELL PERMIT NUMBER <br />E AQUIFER. IfE SHALL TAKE <br />S AND PRECAUTIONS TO PRESERVE <br />,h m ~ly;,js7 <br />APPLICATION APPROVED <br />PERA4ITNUMBER 31662-/~ <br />DATE ISSUED APR 22 1S$7 <br />EXPIRATION DATE QPR 2 31S28 <br />' t... <br />3 ~ ~' <br />Telepnone NO 442-406 L,c. NO ~ <br />(` •iT •. <br />Y/tr~ <br />2 <br />to ~' <br />