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_.. <br />.. r J. <br />~~~i~- <br />-Rev. STATE OF COLORADO <br />M APPLICATION FOR: ®A PERMIT TO USE GROUND WATER h7AA 1715' <br />~ A PERMIT TO CONSTRUCT A WELL GROUND WATEb' <br />Y.O. Addre$a ,~ <br />Quantity a')pl~d for S gpm or <br />AF Storage <br />Casing Plain~in, fron~to~ft. <br />• in. from to ft. <br />Open or Perf~in. from~to~ft. <br />a in. from_to ft. <br />j PUMP ~ Outlet <br />DATA: Type~tn~a.~Q,~ .eHP Size_ <br />Use initiation date //~.~., °0l.,9 19~ <br />(Use Supplemental pages for additional data) <br />PERMIT NO. 2SrJ94 <br />ISSUED: <br />DATE MAR 17 1966 is <br />LOCATION OF WELL D(npNpp(~ <br />County , TJ ~~vuin~.~.s SiATF ENRINE• <br />~~ o~ of Sect. ,3 Q Twp. 3_~.c' <br />Rge.~~_ P. M. OR <br />Street Address or Lot„& Block No. <br />w <br />Town or Sub6ivision <br />N <br /> <br /> <br />-~ - - <br /> <br />i i <br /> <br /> <br /> <br />~ i <br /> <br />~ ' <br /> <br /> <br />Locate <br />well in <br />E 40 acre <br />(small) <br />square <br />as near <br />as possible. <br />Large square <br />is one section. <br />S <br />$25.00 fee required for uses other <br />than Domestic or Livestock. <br />~. <br />t°. d <br />•~ 3 <br />a... <br />wo <br />0 <br />m° <br />..~ <br />V <br />eo v <br />N <br />V <br />mm <br />~m <br />~~ <br />So <br />ca <br />~~ <br />D3 <br />Applicant ~„c¢.i1 ,~-~.~,c•t~ <br />Agent or <br />Driller No.~ <br />Address <br />NOTE -SATISFACTORY COMPLETION REQUIRED FOR APPROVAL OF APPLICATION <br />:A'.'.: <br />r~ <br />Used for~,~ Purposes <br />