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wR~;s~2 COLORADO DIVISION OF WATER RESOURCES ti2a25262j <br />101 Columbine Bldg., 1845 Sherman St., Denver, Colorado 80203 `,L~, - ~ 28a9 <br />PERMIT APPLICATION FORM R' ~~Nt913 ~' <br />Applica?ion must ~ ~l <br />'x complete where ~ ( 1 A PERMITTO USE GROUND WATER a RECE~S~~yces ~v <br />pplieable. Type or (xl A PERMIT TO CONSTRUCT A WELL W~tiE E GiNEEa `~ <br />int in BLACK FOR: (~) A PERMIT TO INSTALL A PUMP ~`S StA CO! ~"~' <br />NK.Nooventnkes 7O2 7~ /b/£~zlll~!b3~/ <br />or erasures unless ( 1 REPLACEMENT FOR NO. <br />initialed. /~ /Q/~~ ~ <br />(Y 1 OTHER /~O~OCr Q /1 y 4/r~~ <br />11) APPLICANT -mailing address <br />NAME <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />Receipt No. '/ `~y 9 7 / <br />STREET //^^ <br />CITY~r~f~0Y1 /d/. ~~dy~ <br />fstatel (ZID) <br />TELEPHONE N0. 1~6~~ Z2~3 <br />(21 LOCATION OF PROPOSED WELL <br />County LG•s .~,~~7a ~ <br />..5~ '/. of the s//~ '/., Section <br />TwP ~~. Rng.y~ ~ . ~P.M. <br />13) WATER USE AND WELL DATA <br />~oposed maximum pumping rate (gpm) ~/~ <br />Average annual amount of ground water <br />to be appropriated (acre-feet),: <br />Number of acres to be irrigated: ~//lA/F <br />i <br />Proposed total depth (feetl: ~~ <br />Apuifer ground water is to be o/b~tained from: <br />~D/1ru/4/~ ~~~4yi4~ <br />Owner's well designation <br />GROUND WATER TO BE USED FOR: <br />(R 1 DOMESTIC 111 ( )INDUSTRIAL 151 <br />(xl LIVESTOCK 12) ( 1 IRRIGATION I6) <br />I COMMERCIAL 141 ( )MUNICIPAL 181 <br />1 OTHER (91 <br /> <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 <br />right or preclude another owner of a vested water <br />right from seeking relief in a civil court action. <br />APPLICATION APPROVED <br />EXPIRED <br />~~ ~- ~ t = 7 31~ <br />PERMIT NUMBER 7 ~ ~ 7S ~r1 <br />(4) DRILLER I DATE ISSUED JUL 2 51973 <br />Name from n?E TZP EXPIRATION DATE JUL 251975 <br />~reet FJ I n m as Ste f R ~. 1.Sn Y d <br />city Ll i~ls~.. 6,,; ,, ~oic <br />IStatel (ZiPI <br />Telephone No. Lic. No. ~ N I <br />~ .~ <br />( A E GINEERI <br />BY <br />I.D. ~ _ /, COUNTY <br />