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•.vR).;.Pei. 'y CO~DO DIVISION OF WATER RESOU ~S <br />818 Cent nial Bldg., 1313 Sherman St., Denver, Colora 80203 <br /> PERMIT APPLICATION FORM <br />Apphca[ion must <br />be complete where 1 I A PERMIT TO USE GROUND'NATER <br />appl~cabl e. T•~pe or IXb A PERP:IIT TO CONSTRUCT A :':ELL <br />print in BLACK FOR: ( I A PERP:IIT TO INSTALL A PUI\1P <br />INK. No overstrikes <br />or erasures unless ( )REPLACE?RENT FOR N0. <br />initialed. IXk OTHER Hydrnlogi c Moni tori no <br /> WATER COURT CASE N0. <br />(1) APPLICANT -mailing address <br />NAME I he Y1 tts tlUrO i5 f91 GWaV Lod I f91 nl ng LC <br />STREET 1120 S. Bellaire Street <br />CITY Denver, Colorado 80222 <br />(smul lGiol <br />TELEPHONE N0. 75q-F5O0 <br />12) LOCATION OF PROPOSED WELL <br />County ROUtt <br />ME % of the SE ,, Section 1(1 <br />T•n'p. ~.(~ _ Rng. 86W 6th P.M <br />~N.S IE.~.v~ <br />(3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate (gpml 3Q <br />Average annual amount of ground water <br />to be appropriated Iacre~feet): fl <br />Number of acres to be irrigated: 0 <br />Proposed total depth (feet!: 425 <br />Aquifer ground water is to be obtained from: <br />le S.S. <br />Oviner's well designation FBR-13 <br />GROUND WATER TO BE USED FOR: <br />( )HOUSEHOLD USE ONLY <br />1 )DOMESTIC 111 <br />I I LIVESTOCK 121 <br />I COMMERCIAL (31 <br />no irngation 10) <br />1 )INDUSTRIAL (51 <br />( I IRRIGATION 161 <br />( 1 MUNICIPAL 181 <br />FOR OFFIC'c USE ONLY: DO NOT WRITE IN THIS COLUMN <br />Receipt No. <br />Basin <br /> <br />Dlst. <br />CONDITIONS OF APPROVAL <br />This well shall be used in such a way as to cause <br />no material injury to existing ~roater 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 />IxboTHERISI Hydrologic Plonitorina I gppLICATIONAPPROVED <br />DETAIL THE USE ON BACK IN 111) <br />14) DRILLER <br />Name Applied Hvdroloay Associates <br />Street 1228 Forest Street <br />city Denver, Colorado 80220 <br />cs~a[el <br />Telephone No 3?3-4504 Lac. No. _ <br />PERMIT NUMBER <br />DATE ISSUED <br />EXPIRATION DATE <br />(STATE ENGINEER) <br />BY <br />I.D. <br />COUNTY <br />