Laserfiche WebLink
. --r l: <br />WRJ~S~Re~. 76 <br />sss <br />Application must <br />be complete where <br />applicable. Type or <br />print in BLACK <br />I N K. N o overstr i kes <br />or erasures unless <br />initialed. <br />COLORADO DIVISION OF WATER RESOURCES <br />818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br />~n <br />.is~.:P~~1~; <br />PERMIT APPLICATION FORM <br />1 A PERMIT TO USE GROUND WATER MIf l , rtJ'~ <br />( ) A PERMIT TO CONSTRUCT A WELL <br />FOR: ( 1 A PERMIT TO INSTALL A PUMP WARRIte.rt;: .; <br /> sT,tTr rNr . r; i~ <br />IX 1 REPLACEMENT FOR N0. ~^"" <br />IX I OTHER,QQEeg~.k{p'~.e <br />WATER COURT CASE N0. <br />(1) APPLICANT -mailing address <br />NAME _~Om. I nr. <br />STREET 9145 Sunshine Canyon Rd <br />CITY Boulder Co 80302 <br />(5\alel IZiPI <br />TELEPHONE N0. ~3Q-TG~1 ~-7 ZL1G <br />(2) LOCATION OF PROPOSED WELL <br />County _$n\ r 1 rlnr <br />_ NN '/. of the SErI '/., Section <br />Twp. 1~ - Rng. 72W <br />IN.SI IE, WI L <br />(3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate 19pm1 _ <br />Average annual amount of ground water <br />to be appropriated (acre~feetl: <br />Number of acres to be irrigated: <br />Proposed total depth Ifeetl: <br />Aquifer ground water is to be obtained from: <br />Left Hand Ditch-~-See~ <br />0 <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />Receipt No~ 3 /~ 02 ~ / <br />Basin <br />Dist. <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 />`l~that no injury will occur to another vested water <br />' right or preclude another owner of a vested water <br />ri right from seeking relief in a civil court action. <br />i <br />/ Access Hole <br />Owner's well designat,bn , e <br />GROUND WATER TO-BE USED FOR: ~ ~ ~ `~ <br />1 )HOUSEHOLD USE ONLY - no irrigation 101 ~ <br />1 DOMESTIC 111 ~ ( 1 NDUSTRIAL (51 <br />1 1 LIVES70CK 121 ~I/~RRIGATION 161 <br />1 COMMERCIAL (41 ( I MUNICIPAL 181 <br />1X I OTHER 191_ACCeGS Nile ~ APPLICATION APPROVED <br />DETAIL THE USE ON BACK IN (11) <br />(4) DRILLER <br />PERMIT NUMBER <br />DATE ISSUED <br />Name frntrnrlwatr>r S~ctems I EXPIRATION DATE <br />Street 4599 N. Broadway IJ <br />City Boulder r(~n RN n~_ I (STATE ENGINEER) <br />Islacei (aP) <br />Telephone No.(30?)442-40 $,Qc. No. 963 BY <br />I.D. COUNTY <br />