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WRJ-5-6; STATE OF COLORADO DIVISION OF WATER RESOURCES <br />~ A PERMIT TO USE GROUND WAT <br />L7 A PERMIT TO. CONSTRUCT A ~L ~ ,, _ ', „c- <br />~ r- <br />APPLICATION FOR: ~ REPLACEMENT FOR N0. ~_= ~ °j <br />~. ~.! ~ C T <br />(Reason) ~~ .. __ a} <br />m .~ <br />Q OTHER .c+ G,;ic s .= c. ~. y <br />• a~ d T.t. ~v ::~ ~` <br />PRINT OR TYPE £~~~ OF SELL <br />APPLICANT William a; ALyr tle -ozniak <br />Street Address Kou to 1. tsox 239 <br />l <br />orado <br />81082 <br />City & State Trinidad; C'o <br />/Use of ground water ~p,rJ~„{ ''// <br />~ <br />l <br />~ - lToq ~ <br />Owner of land on which well <br />is located 1Pilliam fi: h!v rtle eozniak <br />Number of acres -~-- ~ -- ' <br />to be irrigated ---- <br />Legal description of <br />irrigated land ---- <br />Other water rights on <br />__ <br />this land - - <br />Owner of irrigated <br />__ <br />land -- <br />Aquifer(s) ground water is to be obtained <br />from <br />ESTIMATED WELL DATA <br />quantity of ground water to be claimed; <br />~t. Max. Yield 15 GPM or CFS <br />Est. average annual amount to be <br />used in acre-feet --- <br />Storage capacity --- AF <br />Anticipated start of drilling flay 15 192L <br />..,~ ~ = <br />~l j <br />:' =; <br />:`~r :' _ <br />COUNTY Las .lnimas <br />~, L, sec. <br />T. R. ~ P.M. <br />Street or ~.~-- ~" <br />Lot b Blocl. lc.o_t;G` < <br />1/ City or A~Wa//~ ' , eR4 0 <br />Subdivision, tgue~zlT pSa2a <br />- ~-1----- -')iicCai~y Best Tra <br />Ground Water.Basin <br />Water Management <br />District <br />LOCATE WELL ON THE BACK OF THIS SHEET <br />Driller Marior. m. 9'ivder No. 47 <br />Driller's <br />Addressl'.U, ~~BJJo,,,,x 53 Trinidac Colo.8ID08^_ <br />X ~ ~. 9fGG L~ ~rsi~s <br />"" Sig tiure of Appl' ant <br />CONDITIONS OF APPROVAL <br />Hole Diameter; <br />u in. from n ft. to an ft. <br />'in. from ft. to ft. <br />Casing; <br />Plain ~ in. from n ft, to aft. <br />in. from ft. to ft. <br />Perf. ~ in. from aCL_ft. tom ft. <br />in. from ft. to ft. <br />PUMP DATA• Outlet <br />Type -'- HP --- Size --- <br />FOR STATE ENGINEER OR COMMISSION USE <br />APPLICATION APPROVED: <br />VALID FOR ONE (1) YEAR AFTER DATE ISSUED <br />UNLESS EXTENDED FOR GOOD CAUSE SHOWN TO <br />THE ISSUING AGENCY <br />PERMIT N0. 4 5 4 6 4 CONDITIONAL // <br />DATE I SSUED APR 1 6 1971 <br />STATE EN N R or CHAIRMAN GROUND <br />~ e WATER COMMISSION <br />APPLICATION MUST BE COMPLETED SATISFACTORILY BEFORE ACCEPTANCE <br />