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

WRJ-35-751 /
COLORADO DIVISION OF WATER RESOURCES
TYPE oR
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K 818 Centennial Bldg., 1313 Sherman St. 1
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PY OF nCC EP TED Denver, Colorado 80203 ~ 1
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~RE OUES7 STATE OF COLORADO R ff4ii
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STATEMENT OF BENEFICIAL USE OF GROUND WATER ~
~ AMENDMENT OF EXISTING RECORD L
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LATE REGISTRATION ~'
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MIT
UMBER
LOCATION OF WELL
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bung duly sworn upon oath, deposes and says that he (they) is (ore) the owner(s) of the well described hereon, the well is
located as described above, at distances of feet from the section line and feet from the
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section Ilne; wa ter from this well was first applied to a beneficial use For the purpose(s) described herein an the
u•a• e. wn.r
day of 19_; the maximum sustained pumping rote of the well is gallons per minute, the pumping
claimed hereby Is gallons per minute; the total depth of the well is feet; the overage annual amount
of water to be diverted is acre-feet; (or which claim .s hereby made for
purpose(s); the legal description of the land on which the water from this well .s used Is
which
acres are irrigated and which is illustrated on the map on the reverse side of this form; that this well was completed in
compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he
(they) has (have) read the statements mode hereon; knows the content thereof; and that the same are true of his (their) knowledge.
(CO ETE REY7 VE,R;E SSE OF THIS FORM)
Signoturel s) T- W- ^`r--^Qiu-"
Subscribed and sworn Q~
to before me on this ~_ day of /~cS;ItLS~ 19-}/-(~
My Commission expires: 1dYCotntni~onExpiresDa.9.1981
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ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORA00
PUP.SUANT TO THE FOLLOWING CONDITIONS:
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FOR OFFICE USE ONLY I
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1980 ~ Dr'cUTY STATE ENGII~ .
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