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~.YP~~:-Re+. ?; COL~DO DIVISION OF WATER RESOU~ <br />B18 Cente ial Bldg., 1313 Sherman St., Denver, Colorado 0203 <br />PERMIT APPLICATION FORM <br />Application must <br />be ccmplete where ( 1 A PER},11T TO USE GROUND';JATER <br />applicable. Type or Ix~ A PERP.IIT TO CONSTRUCT A WELL <br />print in BLACK FOR: I 1 A PER2:11T TO INSTALL A PUM11P <br />I Is K. No overstrikes <br />or erasures unless ( 1 REPLACE~AENT FOR .V O. <br />initialed. Ix~O OTHER ~ivdrol ogi c Moni tort nq <br />'ilATER COURT CASE N0. <br />(i) APPLICANT • mailing <br />NAME the P1tt5burq & i'1tdw~ Lodl M1 n1na Cc <br />STREET 1720 S• Bellaire Street <br />CITY Denver, Colorado 80222 <br />(S~a~e) (LOl <br />TELEPHONE N0. 759-6500 <br />(21 LOCATION OF PROPOSED WELL <br />County ROUtt <br />PJE ~ of the NE i, Section TO <br />Twp.~_ _,Rng. ~e ~_~ 6th P.M11 <br />N.$i E, WI <br />(3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate (gpm) <br />30 <br />Average annual amount of ground water <br />to be appropriated lacre~feetl: 0 <br />Number of acres to be irrigated: 0 <br />Proposed total depth Ifeetl: 270 <br />A.quif er ground water is to be obtained from: <br />Twentymile S,S. <br />Owner's well designation FBR-14 <br />GROUND WATER TO BE USED FOR: <br />I 1 HOUSEHOLD USE ONLY <br />1 DOMESTIC 111 <br />I 1 LIVESTOCK 121 <br />1 I COMMERCIAL 141 <br />no irrigation (01 <br />1 1 INDUSTRIAL.I51 <br />1 1 IRRIGATION (61 <br />( 1 PAUNICIPAL (8) <br />(XXOTHERI9) HKdroingic P1onitorina <br />DETAIL THE USE Of~l BACK IN (11) <br />(4) DRILLER <br />Name Applied Hydrology Associates <br />Street 1228 Forest Street <br />City Denver, Colorado 80220 <br />Telephone No. 333-4504 Lic. No. <br />FOR OFFICE USE ONLY: DO NOT lVRlTE !N THIS COLUMN <br />Receipt ^!o <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 NUMBER <br />DATE ISSUED <br />EXPIRATION DATE <br />(STATE ENGIiJEER) <br />BY <br />I.D. COUtJTY <br />