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.V?~. ].Re.~. /: <br />Application must <br />he complete where <br />appl~cabl e. Type or <br />print in BLACK <br />INK. No overstrikes <br />or erasures unless <br />initialed. <br />COL~DO DIVISION OF'+VATER RESOU~S <br />818 Cen al Bldg., 1313 Sherman St., Denver, Colora 0203 <br />PERMIT APPLICATION FORM <br />1 I A PERMIT TO USE GROUND 'NATER <br />IX>D A PER?:11T TO CONSTRUCT A :`JELL <br />FORS ( )APE R.11T TO INSTALL A PU~'AP <br />l I REPLACE',1ENT FOR N0. <br />1X)0 OTHER y~drol ngl C Moni Lori ng <br />SVATER COURT CASE N0. <br />(1) APPLICANT • mailing address <br />NAME i ne r1 ttsDUrg r, ran away Loa I rn n 1 nu_~t <br />STREET 1720 S. Bellaire Street <br />CITY Denver, Colorado 80222 <br />(s:a~el fZio) <br />TELEPHONE NO. 759-6500 <br />(2) LOCATION OF PROPOSED WELL <br />County RDUtt <br />SE '; of the SE ',, Section 16 <br />Twp.~_ _ Rng. 86W 6th PM. <br />rv.sl iE,:•n <br />(3) WATER USE AND WELL DATA <br />Proposed maximum pumplno rate Igpm) 3D <br />Average annual amount of ground water <br />to be appropriated lacre-feed: ~ <br />Number of acres [o be irrigated: ~ <br />Proposed total depth (feed: 1975: fi75 ~ 35(1 <br />Aquifer ground water is to be ob[ained from: <br />4ladge coal zone; Twentymile S.S.; K5 S.S. <br />Owner's well designation FBP, - 11 (A, B, C) <br />GROUND WATER TO BE USED FOR: <br />1 I HOUSEHOLD USE ONLY <br />f 1 DOMESTIC (11 <br />1 1 LIVESTOCK 121 <br />1 1 COMMERCIAL lal <br />no ^riganon 101 <br />1 )INDUSTRIAL 15) <br />1 I IRRIGATION 16) <br />( I MUNICIPAL IS) <br />IX>D OTHER 191 Hydrologic 11oni tori ng <br />DETAIL THE USE ON BACK IN (11) <br />(4) DRILLER <br />Name Applied Hydrology Associates <br />Street 1228 Forest Street <br />City Denver, Colorado 80220 <br />Ista~eJ <br />Telephone No. 333-4564 Lic. No. _ <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />Receipt No. <br />Basin <br /> <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 />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 NUiMBER <br />DATE ISSUED <br />EXPIRATION DATE <br />(STATE ENGINEER) <br />BY <br />I.D. <br />COUNTY <br />