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wtiiJ-35-75 <br />'YPE OR <br />PRINT IN BLACK INK <br />COPY OF •Cr EP TED <br />"E+iE xT MAILED <br />:QUEST <br />/ - <br />~/ BY THE OFFICE OF <br />THE STATE EE:GINE~R <br />COLORADO DIVISION OF WATER RESOURCES ACCORDII7G TO TLt.~., <br />300 Columbine Bldg., 1815 $hermon St. DECREE. GRANTED liI+~ER <br />Denver, Colorado 80203 CASE 1i0. F1-7`22 <br />STATE OF COLORADO <br />COUNTY OF <br />YlATER DIVISION 2 <br />I AFg(,~gv~TFT TO SECTIOil <br />1 SS 37-92-304 .(!~8)_.,-gCRS~o <br />DATES :,:Y <br />STATEMENT OF BENEFICIAL USE OF GROUND WATER <br />AMENDMENT OF EXISTING RECORD ~rcbs-r' 36 <br />LATE REGISTRATION ~= as <br />PERMIT NUMBER OZ1O68 "~ <br />THE AFFIANT(S) <br />whose mulling <br />address is <br />Tohn M. Mecom <br />2960 Iazy Lane <br />LOCATION OF WELL <br />ceu~ir Ins Animas <br />NW y, et rhr NE '/.. sea.. e.. 1Z <br />Clry Houston, Te~.s 77001 ..e 33 S R~, 68 W 6th P M <br />lar uri Biel ih o. a~ ~E n. wi <br />being duly sworn upon ooth, deposes and says that he (they) is (are) the owner(s) of the well described hereon; the well .s <br />located as described above, at distances of feet from the section line and feet from the <br />ae... o• as ~,..~ <br />section Ilne; water from this we(I was first opplied to a beneficial use for the purpose(s) described herein on the 31` <br />r.a. o. «.,-. <br />day of DEC. 19~; the maximum sustoined pumping rate of the well is ~6_gallons per minute, the pumping <br />claimed hereby is _~6 gallons per minute; the total depth of the well is ~5_feet; the average onnual amount <br />i~ter to be diverted is 25 acre-feet; for which claim is hereby made for _irri ga+i nn7 Amm~ ef~i rs g~p~ <br />fish and wildlife <br />purpose(s); the legal description of the land on which the water from this well is used is <br />of which <br />acres are irrigated and which is illustrated on the map on the reverse side of this form; that this well was completed in <br />compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he <br />(they) has (have) read the statements made hereon; knows the content thereof; and that the same are true of his (their) knowledge. <br />(COMPLETE REVERSE SIDE OF THIS FORM) <br />Signature(s) <br />$ubscribed and sworn <br />to before me on this _ <br />My Commission expires: <br />~ar.~ <br />day of <br />19 _ <br />ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORA00 <br />?URSUANT TO THE FOLLOWING CONDITIONS: <br />• <br />FOR OFFICE USE ONLY <br />Cevr Coae No. W-722 ~} <br />P•~o. Mo Day __ Y• <br />D,.. 2 cw. 36 <br />W.II uae 6 _~ 2 1 <br />DH. ~__ Bei~~ Maw Dn <br />.+'E STArE a_~7wEE <br />