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d <br />. D (Rev.) <br />l2 , . <br />• <br />1 <br />u <br />I .4TE OF COLORADO <br />~ DIVISION OF WATER RESOURCES <br />OFFICE OF TfiF, STATE ENGINEER <br />GROUND RATER ADMI\ISTRATION <br />PERMIT <br />A'OTE; This pcrmi; is issued for the purposes <br /> <br />indicated in the application. <br />--=t------------^----------------------------- <br />. ! ., <br />Fottn C Rev. STATE OF COLORADO ff'' ~-.~ <br />,.'-U <br />8-82/IOM APPLICATION FOR: ®A PERMIT TO USE GROUND WATER',,.,_-^,~ u~i'r`""y7`)gE_ <br />A PERMIT T'O'CONSTRVCT'7I~'WELL '°- ~ , <br />Applteant~„c~: ~~~ LOCATION OF WELL . GC~0~,70 <br />.' ~ ~ .. C.OUa1V /ve-~/YN.Q.1rr.TC n>n~'_- <br />Quantity applle or_~' /5~ 8pm or ~~ of ~~ of Seet..3l] Txp.~.a° <br />AF Storage <br /> <br />Purposes <br />Used for ~ <br /> ` <br /> <br />on/at <br />~~,: 3 D <br />~c~~t . <br />° <br />. <br />~ (legal description of Land site) <br />~3 <br /> <br /> <br />TotaTcr age !trig ed and other rts. S ~ <br />ESTII.fATED DATA OF WELL =__° <br />" <br />Hole size: in. to~(~ ft. v <br />1n. to ft. _ <br />`c °~ <br /> <br />Caeitig Plain~in. trom~to~it. R <br />~ " <br /> <br />So. from to ft. u <br />Opea'or Perf~in. from~to~it. ~ <br />in. from to ft. 2 m <br />utlet <br />PUMP V <br />,'Ya-- ~~ ~ <br />HP Size <br />DATA: Type""=~5~s =. <br />_ <br />A <br />lnitiatipn date //~.~ ~ A 19~. <br />Use:: a•.a <br />_ <br />(Use Supplemental pages for additioral data) _~_ <br /> ~_ <br /> <br />PERMIT NO. 2~5~•'1 <br />ISSUED: <br />DATE MAR 17 19bfi 19_ <br /> <br />Stree Address or L~otr9~ B1ock.No. , <br />Tows or Su fvieloa.: - _ <br />.. <br />t <br />1 ~ <br />1 .. _ . 1 <br />-'.~.: <br />: <br />1 ~' <br />l i <br />I ~ ~ ~~. . <br />-`°~ Locate ~.1:'i. . <br />~.' well !n':.;~•ti;: <br />~. 'rcy:: <br />40=ure :. <br />squat ~-- <br />'as near=':~` <br />= as` possible, <br />''~a~ge"square" . <br />to oae ~ectioa. <br />$25.00 fee required for uses other. <br />than Domestic or Livestock. <br />:+ <br />Appllcaat ~„c¢r I,r~t~,t.L, ~_ <br />Agent or <br />in-il ler~_No. <br />Address <br />NOTE -SATISFACTORY CnMPLETION Rf:~tiIRED FOR APPROVAL OF APPLICATION <br />• TfiE ABOVE APPLICATI(Sn PEI~G A [':~.:t ~)F 'I'BIS PER1~fIT, !S APPROVED AS <br />INDICATED. G%2~ Q~~~ <br />S ATE ENGINEER <br />SEAL I ~ '/~ I~~~ <br />. ~ <br />