PERMFILE62861

• Permit No: C1981012
• IBM Index Class Name: Permit File
• Doc Date: 7/28/1986
• Section_Exhibit Name: EXHIBIT 11 WATER WELL INFO PART 2
• Media Type: D
• Archive: No

M ~ ~ .. .. i c yr i.~c~rtNw ~` _;
Inge. no. O DIVISION OF WATER RESOURCES ,
IDWD Zi- ~` OFFICE OF THE STATE ENGINEER .I,QN
&RpUND 7 i9I0
Use
Reg~ste~ed MAP AND STATEMENT FOR WATER WELL FILING ~ (rtQjnp ~ `~i
3 8 5' ~~~
PERMIT NUMBER
•TATEOF COLORADOI )
S$
COUNTY OF ~ =~
Know all men by these presents: That the undersigned
v
claimant(s), whose oddre3ssir~~' ~ ,
CiTy ~yl~w ~ ; ~,~109/ ,states: .
Claimants} is (ore) the ow}ter(s) of the well described hereon;
the total number of acres of land to be irrigated From this well
is~qq; work was commenced on this well by actualpcon
srruction~doy of _~ r ,1912[;
the yield to be used from said well is ~d (gpm), for
which claim is hereby made For ~ purposes;
that the averagr annual amount of water to be diverted is
• ~~ ~'ecre•feet; and thot the oforementioned
statements are made and this map and statement are Filed in
compliance with the law. ~ ~.
Claimonr(s) -~
Subscribed before me on.t is ~ day of
~_~,
My commission expires ~'~°-~- ~~1~:-~~/ 7.3.
Q ~ i .1r
Notary Public
WELL DATA Q/,'
Date Completed ~~'t~'t ~ ~ ~ / / v
Static Water Leqvelq~ Q ~r.
Total Depth d 9~~
Y0' ~ - • ~ WELL LOCATION ~ /
~f.2A ,Q,,,,ytnia.~A.d ~ .~ aCoun ry
V
~ E~ % of .S ~, %, se~. ~a~
~.
T. R. P.M.
I ~ ..
INDICATE WELL LOCATION.ON DIAGRAM
-.
- NORTH.
N
w
3
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SOUTH
WELL SHALL BE~LOCATEDWITH REFERENCi
TO GOVERNMENT SURVEY CORNERS OR MON
UMENTS, OR SECTION LINES BY DISTANCI
AND BEARING.
ft, from section line
(North or South)
ft. from section line.
(East or West)
Ground Water Basin !~r•r +~w
Water Managemen
District ;fir-•-r~'-+~-
Domestic wells may be located by the following
LOT
SUBDIVISION
FILING ~
BLOCK
ACCEPTED FOR FILING IN THE OFFICE OF THE STATE ENGINEER OF COLORADO ON THIS
DAY OF 19
• State Engineer
)RM TO BE MADE OI
WHITE copy & GREEN co
is for the Owner & YELLC
T BE AN ORIGINAL COPY ON BOTH SIDES AND SIGNED.
must be filed with the State Engineer within 30 days after well is completed. PINK copy
copy is for the Driller.