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;,e:.;.:e., ;; COL~DO DIVISION OF WATER RESOUF~S <br />818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br />PERMIT APPLICATION FORM <br />Application must <br />be ccmpiece :vhere ( 1 A PERT.IIT TO USE GROUND !'DATER <br />apohcabl e. Tyce or IXXI A PERMIT TO CONSTRUCT A WELL <br />pant in SLACK FOR: f I A PERh11T TO IiJSTALL A PUitiiP <br />I PJK i`JO OV erstrikes <br />or erasures unless ( ) REPLACEME~`JT FOR N0. <br />initialed. (Xk OTHER ~~drrJlOoi C ~1oni tori ng <br />:'.'ATER COURT CASE N0. <br />(1) APPLICANT ~ mailing address I FOR OFFICE USE ONLY: DO NOT ~NRITE IN THIS COLUMN <br />NA.AE i ne f l rtSDUrg b rn ewav LDa i I°i i n rnu ~t <br />STREET 1720 S, Bellaire Street <br />c1T•r Denver, Colorado 80222 <br />R~a~e) ltiol <br />TELEPHONE N0. 7Sq-6500 <br />(2) LOCATION OF PROPOSED WELL <br />County RDUtt <br />SW ; of the NE %:, Section 15 <br />Twp.~~ _ Rng. 86!•1 6th P.M. <br />n~.jl E.1Y~ <br />13) WATER USE AND NIELL DATA <br />Proposed maximum pumping rate IgPm) 3D <br />Average annual amount of ground water 0 <br />to be appropriated lacre~feet): <br />Number of acres to be irrigated: U <br />Proposed total depth (feet!: 370; 85 <br />Aquifer ground water is to be obtained from: <br />Twentvmile S.S.; K5 S.S. <br />O~.vner's well designation F6R-12 (A,g~ <br />GROUND WATER TO BE USED FOR: <br />I I HOUSEHOLD USE GNLY ~ no irrigation 101 <br />( )DOMESTIC I1) I )INDUSTRIAL I51 <br />I 1 LIVESTOCK 121 1 1 IRRIGATION 161 <br />! 1 COMMERCIAL 141 1 f MUNICIPAL (BI <br />IXNOTHER191 Hvdrningic P1Dnitoring <br />Receipt Plo. <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 ~,vater <br />right or preclude another owner of a vested water <br />right from seeking relief in a civil court action. <br />APPLICATION APPROVED <br />DETAIL THE USE ON BACK IN 111) <br />(41 DRILLER <br />Name Applied Hydrology Associates <br />Street 1228 Forest Street <br />PERMIT NUMBER <br />DATE ISSUED <br />EXPIRATION DATE <br />Dty Denver, Colorado 80220 <br />(S~a;e) (Zioi <br />Z d <br />Telephone No. - 5D Lic. No. <br />(STATE ENGINEERI <br />BY <br />I.D. <br />COUNTY <br />