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<br />t.b :i3;iALC uN., ,Ch :; r" `~fA ", `2 '~~..J.IR.. E.5 <br />O_°APARTrdE:: T OF ;:A 1'U?~ L BESOU,KC`S <br />1:'13 SHF_idMAi{ ST., RM 318, UENVI~i, CO Fn:t03 <br />prwrre-irtio: (:1D3)356-.75N7 main: (JD3}8eF-J591 <br />taz-(i(1J)$6633R8 hI1 Q'./wNw. Wdler.SlatC.a1-US _~ _ _ <br />•i'C!.:r 'I's2)i `'@t'Yllt`t i~~`,`;Ir'c1.I t.,1i <br />u ina VVC:ION: un HVmsa siAr: niim :n comnletinn lo.r. <br />nnn r:nrst Le cu~nVNiea ur Gieck nr blue v i'r. or'. pac. <br />t. A;:;dicant Inicrrr;ati:m .____.__._. ___-__ <br />r ui ulM'sm. _ ...... ._. <br />Cdppla Creek & Victor Goltl Mining Company <br />M+uv aMr^u <br />PO Box 103 ' <br />cry sma - rv ~e• <br />Vidor ~. CO .80860 <br />T•Ieglabl <br />® ConsbuU new well ^ Use existing well ' <br />d Replem exisbp vreM ^ Cttaige or kxsease use <br />^Change source (aquifer) ^ReappNratlgn (expred Garrnrtl <br />Wii CnN 4v~ __..-... ... <br />02CW122 <br />_. <br />-_ 1 <br />5. Gsa Of 'd'Jrfll ;^hac'c .!ppGr;3ble nexesl <br />T1YerY, v ilalaiie~ Ces7pcon nt uses 1%-plied n:r. <br />Q~v likustrial ^ Other (describe): <br />^ Munklpal <br />^ Irrigation <br />^ CartmterdAl <br />MaYTYT pY^!1Y5 n1^ •_... ... PM Wl mgv[IOMwNM.M .. .. _ <br />500 - ~ gm' ogle 30 acre-reel <br />TGM MpN. .. .... .__. _..._.Kblr.__... _ .._.._... <br />6 feet am, n/a <br />.Land n c roun a <br />ter WIII Be Used <br />Legal Dasaipgan lmaYaao+b.vx .ucn:^.^p: . <br />T. LUG4YVII Vr V3tlY .11C1r <br />_._. _. ~_ ._ _ ._._... .. (Il ae_E lwa_op mpl alla_c_h _es bd ap Nal aM1mvf mpaW_aA__a.)_ <br />ryµ' ~ .__ .._ _ ..... ... _ <br />Teller SW ,..m.^. SW o. A •.~.. a o.^. <br />_ _ <7 CCdV Gold Mining Ca. <br />R+ny. E W ... pi'e.'1pa1.Witlian .._ _ . ___.. _ __.... _ .. _. _. _ .. .. <br />3:Na. -- _rlaAs ~ N e <br />30 1 15 ^® '. 69 ^® ': C uw.^r wn..rNa..w ny:M ae w. a^a <br />_ ....__.~_t-.._ ._.___ <br />uauuawno-w..ebn rbr l.~' ^~ua+++MO~+M'^tlww+~ia~.ei <br />-560 n ba^^ N ®S -150 - a ^tl^~ E ®`H 9. Pro osed Well Griller License A' o tlonal :NIA <br />-€-.miarl..~.q=~^p..~a °'tl"""°"°""'Xti""'""~---- 10. Signature Of Appltcant(s)OrRuthortzed Agent <br />The making fate smiemenb harem wrvtllules perjury in gte secmd <br />~~~.~~._~.~.~~______.___.___ ..-T.. _.______. ~~ la puriunahleg~ adasa irt2sdemearar pursuant to C.R.S. <br />Na 244-7 1 (a). I have re$y'the statertergs herein; know the wirtmb <br />wYd~eck GPa unafar tequsad setlmga as folbwa: <br /> <br />.as>am^.a <br />Eutinn .__ __ A___ __._ _..... _~__...___.____ __ _ <br /> <br /> <br />uMmulbwbbw mu (]t(iCa t150 QnIY <br />wnGV3 urtltca kW bwWai ^YES gamambrW ial OaNmIa NAOaI -"USES mi ._.___...__.__. .. .. ___. __~m _...____ _ .. ___. <br />5. Parcel On Whteh Well Will Be Lotatad <br />- .~ .~- <br />; <br />GYy'(lr (~,.~ ~ ' " <br /> ~, <br />A Legal Oesmpiign lmaYapreaatl ban nbaxmamk ~ Receip(area any <br />WE <br />.. ._.~ __ _ ... _ ._ .._ _.... __.. ~_- ,Mi <br />B. YMw•a In W2M ', G. Owrv <br />' ' CCBV Gold Mining Co. cWCa <br />0. ~ vna w. c. m. ^~+r.w~rw v.wT ~vES ®rw Pi ^•-im ^n..~...~nl rav <br />Mrwa <br />E. sw hAamrfwW^+k ses <br />olv v wo~ en_ Mo <br />Tfaflb !VIJlRt7?r..Ji:Q! tJ.l y <br />i11{tILUI:b L:LtIVI YNl <br />YolariUa .fiannsan S'I ~) <br />Tatbl Trans A1Tit: $1{70.4c7 <br />CREDIT CAl7CI <br />Tamar Afr10unt: y100Aa <br />