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COLOR~LDO DIVISION OF WATER RESOURCES <br />DEP.aRTMENT OF NATURAL RESOURCES - - - <br />~313 SHERL~fAN ST., RM. 818, DENVER CO 80203 ~/~~/o,~L~~ <br />phone -info: 13031 866-3587 main: (3031866-3581 / <br />GENERAL PURPOSE Water Well Permit Application <br />(Plaaae note: other farms acs avolahle for rpscn<e uses inUUding -residential, liveattlek, memtoringlohserv., prevel pits, regsoation of oW wNlsl <br />Review instructions prior to comoletina form Must be completed in black ink ar tuned <br />n.m.., we.. <br />P..C. Burke and Aeather Burl:e <br />MWV AaGa <br />~' 31932 County Rd. 5 <br />1 <br />cn. <br />Y <br />stifle <br />CO <br /> <br /> 2. TYPE OF APPLICATION (check applicahla boxlesll <br />~' Construct new well ^ Use existing well <br /> ^ Replace existing well ^ Chanpe ar Increase Use <br /> ^ Chanpe (sour«I Aquifer ^ Reapplimtion laa..d panne! <br /> ^ Other: <br />. 3. REFER TO lif apoliphle): <br />w.cu rnurt c+u r <br />P+mx r <br />-VE- <br />~a <br />MH- <br />ce,avr <br />~ Rio Blanco <br />Srmn <br />s a,~ Drtanca el wW k <br />-iL.~j 2,723 1 <br />w.a tar rw.. <br />FGA' <br />Ou+rto/au+rar <br />:1W +/ <br />N>! Rrpa EerN <br />~~s 97 n r~ <br />+aomn M <br />+eLnawYdeman[ r <br />6. USE OF WELL (please atarh detailed descriotionl <br />^ INDUSTRIAL SXOTHEA: <br />^ COMMERCIAL domestic and household <br />^ MUNICIPAL <br />^ IRRIGATION <br />^ FEED LOT - number al head <br />7. WELL DATA <br />~~ ~"~ ~. 15 +..r ~ 1 <br />qpm arJa-feat <br />r.r a..w +..w <br />1 r!r1 Mt C~..A t c~.,.,..t <br />0. LEGAL DESOAI/TION Imry b+ pnMdad r +n acachm+ntl: <br />VW 1/4, SWl/4, Sec. 11, TLS, R97?1, Sthp. <br />IN used la tape itria+don. aRaCh seWd msp slut shwa ingrt+d sisal <br />!...en. G Omar <br />!~/A I <br />list r1 athv w.aa er wabr dyke uwd nn tli+ In,d: <br />tr. ur...w+ws. <br />Interstate 6later Well 1239 <br />o°~ 10. SIGNATURE of aoplieantlsl or authorized a0ent <br />SE y. The nuking of false statemtxtts herein corutitutes perjtay <br />°naw" ""1°" in the second degree, which is ptatisluMe a9 a Class 1 mis- <br />t 6th demeanor pursuartt to C.R.S. 24~-104113)1a1. I have r_ad <br />the statements herein, know the contetm thereof, and state <br />h van a^tade ^ W t LYY. ;.tev ace true t0 .T.y '..x:.vledge. _ <br />11 miles S. of Htry. 64 on Piceance'Creek <br />wM.r~rw ..r+ w+r • d+rrr +r bs+~, aaw w .r .,...r <br />feet drectiar <br />LEGAL DESCAf/nON Imry M pNWtl r r setaelVn+ntl: <br />_7FI I/4 of SE 1/4, Sec. 11, T15, R97?l, <br />6ch p.m. <br />• B. STATE PARCEL <br />IDf lepde~ull: <br />~ acncy .. <br />E. VK71 this bs the only weB on this tract? <br />~ YES ^ NO CI etnar w«Is sra on te+is tnet a <br />7/ <br />,-. <br />7tflca Uas Only <br />RECEIVED Dlv~ <br />ppR 0 91559 Co 52 <br />CDLD DN OF WATFA BEti <br />DN19101[FCgS iF~/14c^ 44?999 WE#.~c'! <br />r , rn nrrv:nn-- <br />n1 o^r~~~~~~,,~t.~ <br />~f1~1cA~ BA_ <br />MD _ I <br />Ferm GWS-35 (1J9i1 <br />