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OFFICE OF 'IIIE STATE FNGD'tQ~B - DIVISIt2f OF WAT178 R>E6Q1R[FS <br />NAME ND. .DIV. DIST. ' <br />•, cry .r: ~ ,, r.~ r~S ;:rii,r.. iti: ,,L1 <br />NOTICE OF IMII~i[ 10 ~ISIIBICS A I{QiR~ISDICI'IQ1Al. IIATIS D~f[ SDI[AC11IIt8 <br />This notice is required d6' law pursuant to Section 3T-87-125, C.R.S. (1984) <br />(Must be submitted to the Division 6hgineer 10 days prior to can.9tructian) <br />OWNFIt INFORMATION <br />NAME <br />ADDRESS <br />Street P.O. Box Rural Roate <br />City State Zip Code <br />Telephone ~~ <br />Responsible Person <br />Address <br />Street P.O. Box Rural Route <br />City State Zip Code <br />STRUCTURE INFORMATION <br />Name of Dam: Water Div. <br />Location: Qtr. Sec. _ Sec. _ Tosaship _ Range _, P.ll. <br />Vertical Height ft I,eogth it Slopes, U/S D/S <br />Capacity __A.F., Drainage Area acres <br />Spillway Width it., Spillway Freeboard it. (rertinl Lataa from btta. of spillay to erect <br />at daf <br />Outlet Type Size inches Hater Court Case No. <br />Stream Name <br />Signature of Amer Date <br />DIVISIIx'i ENGINEIItS RI3IAR85 <br />Division Engineer <br />Vertical height is !0 feet or less at longitudinal centerline of dam Erna lo~est paint line, and iapounds 100 acre- <br />feet or less of Aater. <br />IR:920t1:f01t~ <br />