Laserfiche WebLink
WP,J-S~Re+. 76 <br />Application must <br />!x complete where <br />applicable. Type or <br />print in BLACK <br />I N K. N o overstr i kes <br />or erasures unless <br />initialed. <br />PERMIT APPLICATION FORM <br />( 1 A PERMIT TO USE GROUND WATER <br />1 A PERMIT TO CONSTRUCT A WELL <br />FOR: ( I A PERMIT TO INSTALL A PUMP <br />( )REPLACEMENT FOR N0. <br />IX 1 OTHER ~ o/'f ~ <br />WATER COURT CASE N . <br />• mailing address <br />NAME A !~ _a¢SOV/'~QS Zile <br />STREET IH3 ~~ Ff i5~, way ! 2 <br />CITYw~f~^ ~~ $/0~1 <br />(State) fZIP) <br />TELEPHONE NO. ~~ I~) ~6g-~ 1(0 <br />12- LOCATION OF PROPOSED WELL <br />County c.~s A~ i/\ctf <br />N ~ '/. of tne_/V ~./ 'G, section <br />Twp. ~3_ S .Rng.~ w. ~_P.M <br />I N.51 I E.VII <br />• (3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate (gpm) <br />Average annual amount of ground waterN 14 <br />to be appropriated (acre-feed: <br />Number of acres to be irrigated: ~~ /i <br />Proposed total depth (feed: ~ ~, <br />Aquifer ground water is to be obtained from: <br />oyer6vAnr-dew ~ Rh ~o~ ~ <br />Owner's well designation N /' 1 13 - g 4 (NM d ~ ) <br />GROUND WATER TO BE USED FOR: <br />1 I HOUSEHOLD USE ONLY <br />( )DOMESTIC (11 <br />( )LIVESTOCK 12) <br />1 COMMERCIAL 141 <br />COLORADO DIVISION OF WATER RESOURCES <br />818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br />no irrigation (01 <br />( I INDUSTRIAL 15) <br />( I IRRIGATION (61 <br />1 MUNICIPAL (81 <br />(~VOTHER191 MO/tl~prl~ol <br />DETAIL THE USE ON BACK IN (11) <br />(4) DRILLER <br />. Name Sh0.r'pes ~/'l 111 n <br />Street .~ ~ 3 6~ ~ I A ~. W A V 17, <br />city Trin~o{ad Gn. BfOB~ <br />/ 1 (Stara) (ZIP) <br />Telephone No. \~ t ~ l ~ ~L" ~$B~Lic. No ~°~a` 3 <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />peceipt No. <br />Basin <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 water <br />right or preclude another owner of a vested water <br />right from seeking relief in a civil court action. <br />APPLICATION APPROVED <br />PERMIT NUMBER <br />DATE ISSUED <br />EXPIRATION DATE <br />(STATE ENGINEER) <br />BY <br />