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wrtl•s,R... r6 <br />Application must <br />be complete where <br />Ipplicable. Type or <br />Ini in BLACK <br />K. No overstrikes <br />or erasures unless <br />initialed. <br />(1) <br />NAME <br />address <br />STREET) G'C_prtxF. ~~aUFa <br />CITY ~~/FS~On ~. LOIO. S <br />tsuul tnPl <br />TELEPHONE NO. <br />(2) LOCATION OF PROPOSED WELL <br />County ~L_U s A n; .n a s <br />~. F:. Y. of the n• ~ . %, Section ~~ <br />Twp, ~,~ S, Rng. ~~ ~, 6 ~' P,M <br />N, 51 I E,Y/1 <br />(3) WATER USE AND WELL DATA . <br />~oposed maximum pumping rate Igpml /~ <.Pn7 <br />Average annual amount of ground ter y <br />to be appropriated lave-feet): ~ Q[^ t'~ ~OO/ <br />Number of acres to be irrigated: nd nF_ <br />Proposed total depth (feet): ADO <br />Aquifer groundwater is to be obtained from: <br />~. <br />Owner's well designation <br />GROUND WATER TO BE USED FOR: <br />IX} HOUSEHOLD USE ONLY <br />~ 1 DOMESTIC 111 <br />I LIVESTOCK (2) <br />I COMMERCIAL 14) <br />1 )OTHER 191 <br />no irrigation (01 <br />( )INDUSTRIAL 151 <br />( )IRRIGATION (61 <br />( 1 MUNICIPAL 181 <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />Receipt No. ~! d / / / <br />Basin <br />I, ok <br />r~..~ <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 />APPROVED FOR HOUSEHOLD USE ONLY, FOR Oil <br />(1) SINGLE FAMILY DWELLING AND NOT TO BE <br />USED FOR IRRIGATION. THE RETURN FLOW FROWI <br />THE USE OF THIS WELL MUST BE RETURNED TO <br />THE SAME STREAM SYSTEM IN WHfCH THE WELT <br />IS_ LOCATED. <br />"~ !d'JNICIP_4L OR COUNTY G07ERNMENT <br />S&P.LI, BE CONSULTED WHEH LOCATING <br />THIS WELL, AND THEIR REGULATIONS <br />SHALL BE CODtPLIED KITH. <br />~XPIRED~ <br />DATE 3- 3 f- S Z ~ ~Z~s z <br />APPLICATION APPROVED <br />DETAIL THE USE ON BACK IN (111 113394 <br />PERMIT NUMBER QR <br />14) DRILLER DATE ISSUED MAR ~ ~ 198 <br />Name A~FX ~odct.f EXPIR DATE MAR 21198 <br />(~~~ fax a9s ~+ <br />reer ~ - G <br />/~ <br />ity ~n k f d4 ~ ~ l d~0~ ~~~~ ISTATE/~'.J}~'G/~µ~~~EFj) <br />ISiatel (Z,PI // I %/ / I <br />COLORADO DIVISION OF WATER RESOURCES <br />818 Cente nnial Bldg., 1313 Sherman St., Denver, Colorad <br />o 80203 <br />C,~_.D <br />` E <br />PERMIT APPLICATION FORM RC ! ED R EIVED <br />~` J tj(jj Z 19~ F~'~ ~~~ <br />r~ ~9~ <br />1 ( 1 A PERMIT TO USE GROUND WATE <br />~~ ~~ <br />~ 1X1 A PERMIT TO CONSTRUCT A WELL <br />$~ff ~~ Ifs iBOURCES <br />A: ~ <br />,HAt c: <br />yGW 4 1 A PERMIT TO INSTALL A PUMP <br />~ ~ ~~~ <br />D <br />iu`tE~ 1 )REPLACEMENT FOR N0. ~ <br />_ ( )OTHER <br /> WATER COURT CASE N0. <br />~--- <br />Telephone No. non F_ Llc.NO. St/~_I BY ~ !~• rive <br />I.D. ~~~ COUNTY <br />