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<br />-~ wR~.S•Rr.. ia, COLORADO DIVISION OF WATER RESOURCES RECEIV~p <br />' 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br /> AUG 0 8 198 <br /> PERMIT APPLICATION FORM <br />Application must i wgTER RESOURCfs <br />be complete where ~ ~Q A PERMIT TO USE GROUND LVATER STATj. EHGIflEFB <br />.applicable. Type or ~ A PERMIT TO CONSTRUCT A WELL __ <br />_ . <br />COLE <br />print in BLACK - <br />FOR: (~q.A PERMIT TO INSTALL A PUMP - _- <br />INK. NO Overstrikes ___- . . __.-, <br />or erasures unless 1 1 REPLACEMENT FOR N0. _ _ _;_ <br /> <br />initialed. <br />( (OTHER <br />_ - <br /> <br />_...u0 <br /> WATER COURT CASE NO. ~yF ~L;~ ._;_I <br />1 <br />ng address <br />/NAME lCe l~ne~ ~, ~.c~.a v-y.00F <br />STREE(T~ /22o£s lsI'~Net~ CT. N t. <br />CITY Tt~~~ ll~.>rT.Q N M_ R'7l l Z <br />(State) (LO) <br />TELEPHONE NO. CC'CS'~ 1R(~348$' <br />(2) LOCATION OF PROPOSED WELL <br />C4untY aG ~1A ~r lu ,.c ~~rWU~:,. ~1o y-Yt0.o <br />~Trs~ N_ W. '/. of the N g. G, Section 9.5 <br />Twp. 3o3_ 5 , Rng. _ G k kJ ~P.M. <br />~ W.A iE.wl <br />(3) WATER USE AND WELL DATA <br />~roposed maximum pumping rate 19Pm1 /O <br />Average annual amount of ground water <br />Ito be appropriated (acre-feed: <br />Number of acres to be irrigated: <br />Proposed total depth Ifeetl ~ S-5 <br />Aquifer ground water is to be obtained from: <br />Owner's well designation <br />GROUND WATER TO BE USED FOR: <br />b4 HOUSEHOLD USE ONLY <br />I DOMESTIC (1) <br />1 LIVESTOCK 121 <br />1 COMMERCIAL 141 <br />( I OTHER 191 <br />no irrigation (01 <br />1 1 INDUSTRIAL (51 <br />( 1 IRRIGATION 161 <br />1 I MUNICIPAL I81 <br />DETAIL THE USE ON BACK IN 1111 <br />(4) DRILLER <br />i c~u` 5-e~ ~ r. ~1,Q,~ <br />Name <br />`treet <br />City <br />)Scowl IZ,oI <br />Telephone No. Lic. No <br />FOR OFFICE USE ONLY <br />Receipt No3a3593"`~-1~ <br />NOT_l~VR1T <br />_ ::SS3 <br />THIS COLUMN <br />Basin Gist. <br />CONDITIONS OF APPROVAL <br />This well shall be used in such a way as to cause - y <br />no material injury to existing water rights. The ~~~~„t <br />issuance of the permit does not assure the applicant -~ „a <br />that no injury will occur to another vested water 21 <br />right or preclude another owner of a vested water <br />right from seeking relief in a civil court action. <br />ISSUANCfi OF THIS PfiRMIT DOfiS NOT <br />~UAFfiR ___-- -OFi'i'-- <br />1) APPROVHD PURSUANT TO CRS 37-92-602(3)(b)(II) <br />A AS THH ONLY WHLL ON A RHSIDfiNTIAL SATE OF <br />6 ACRHS DfiSCRIBBD AS THAT PORTION OF THH NB <br />I%4 OF SHCTION 29, T33S R68W OF THH 6TH P.M., <br />LAS ANIMAS COUNTY, BHIN~ MORH PARTICULARLY <br />DHSCRIBHD ON THH ATTACRHD HXBIBIT "A". <br />2) THB USB OF GROUND WATBR FROM THIS WBLL IS <br />LIMITED TO ORDINARY HOUSEHOLD PURPOSHS INSIDE A <br />SINGLE FAMILY DWBLLING AND THfi WATHRING OF THE <br />USBR'S NONCOMMBRCIAL DOhIIiSTIC ANIMALS. THB <br />GROUND WATER SHALL NOT BB USBD FOR IRRIGATION <br />OR OTHER PURPOSES. <br />3) THE RETURN FLOW FROM THH USH OF THIS WBLL <br />MUST BE THRU AN INDIVIDUAL WASTH WATfiR DISPOSAL <br />SYSTfiM OF THH NON-HVAPORATIVB TYPB WHHHB THH <br />WATHR IS RfiTURNHD TO THH SAMH T~~ YSTHM IN <br />WHICA THE WHLL IS LOCATBD.$• <br />APPLICATION APPROVED <br />PERMIT NUMBER ~`~~' }-~ <br />I.D. ~ - ( 1 COUNTY <br />DATE ISSUED AUG 2 4 1999 <br />EXPIRATION DATE ~~-V rJ - ~~~" <br />