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WRJ~S-Re.. 76 COLORADO DIVISION OF WATER RESOURCES <br /> 816 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br /> ECEIVE <br />D <br /> PERMIT APPLICATION FORM ~ ~ ~ <br />Application must '. o. <br />APR 2i 6 1982 <br />be complete where <br />i <br />l ( 1 A PERMIT TO USE GROUND WATER <br />P <br />R j <br />WATER RESOURC~LS <br />opl <br />cab <br />e. Type or ( 1 A <br />E <br />MIT TO CONSTRUCT A WELL , <br />Int in BLACK FOR: ( I A PERMIT TO INSTALL A PUMP r1TAT[ ENG1n.EP <br />NK. No overstrikes Flo <br />or erasures unless ( 1 REPLACEMENT FOR NO. <br />initialed. (w OTHER YCaf~/c¢!-ien /' arc ..cal ./. +':. a~//335sa <br /> WATER COURT CASE NO. <br />re55 <br />NAME ~+r,C/~~-+ I\. (.~4Ue Z <br />STREET C~-~f- GCeI`uP C~~1rPZo <br />CITY ~UeS lc,lt lr. ~n alG~` <br />lsut.l izlol <br />TELEPHONE N0. $6$ ~ ~ al <br />(2) LOCATION OF PROPOSED WELL <br />County ~4.5 Ail ii11.0 S <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />i <br />Receipt No. -~ ~ ~ ~ / <br />or - a.f , /o c -O/C <br />Basin 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 r= <br />right or preclude another owner of a vested water . . <br />right from seeking relief in a civil court action. <br />N• E' % of the N~ ~°, Y.,Section~ <br />Twp.__33~ S,Rng.~O_ ~, ~P.M <br />IN.51 IE. WI <br />(3) WATER USE AND WELL DATA <br />`oposed maximum pumping rate (gpm) ~Q G. /. ~. <br />Average annual amount of ground water -1- <br />to be appropriated lacredeetl: I ocre Fen l <br />Number of acres to be irrigated: /I G 11 ~ <br />Proposed total depth (feet): IG d ~ <br />Aquifer gro/u'nd water is to be obtained from: <br />u/I Know n <br />Owner's well designation <br />GROUND WATER TO BE USED FOR: <br />APPROVED FOR HOUSEHOLD USE ONLY, FOR ONE <br />(1) SINGLE FAMILY DWELLING AND NOT TO BE <br />USED FOR IRRIGATION. THE RETURN FLOW FROM <br />THE USE OF THIS WELL MUST BE RETURNED TO <br />THE SAME STREAM SYSTEM IN WF~ICH 7HE WELL` <br />IS LOCATED. <br />THE MUNICIPAL OR COUNTY GOVERNI~NT <br />SHALL BE CONSULTID WHEN LOCATING <br />THIS WELL, 9ND THEIR REGUL9TIONS <br />SHELL BE COMPLIED WITH., <br />APPROVED AS A REAPPLICATION <br />AND REINSTATEMENT OF WELL <br />PERMIT N0. 113 39 ~F <br />1)(1 HOUSEHOLD USE ONLY ~ no irrigation 101 <br />1 1 DOMESTIC (11 ( 1 INDUSTRIAL 151 <br />1 1 LIVESTOCK (21 ( 1 IRRIGATION I61 <br />1 I COMMERCIAL (al 1 1 MUNICIPAL 181 <br />1 1 OTHER 191 <br />DETAIL THE USE ON BACK IN 1111 <br />APPLICATION APPROVED <br />(4) DRILLER <br />Name A I E 7( nn1.) C C' ci u <br />~reet ~• tr7' I.J n Y a 5 S <br />city C~~Ke~)-,le C~.(o, (c32 <br />lst,rol C/ cz~ol <br />Telephone No. /l e ~ E Llc. No. 8 1 <br />PERMIT NUMBER A 113(f3] R 4 <br />DATE ISSUED MI1Y `~ 1982 <br />