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<br />wRJ-25.75 • <br />COLORADO DIVISION Of WATER RESOURCES <br />TYPE oR 818 Centennial Bldg., 1313 Sherman St. <br />PRInT IN Bl>CK INK <br />COPY OF >CC EP TED Denver, Colorado 8(1203 <br />57>7EME NT M>ILED <br />or+ REOUesr. STATE OF COLORADO I <br />} 55. <br />COUNTY OF Denver I <br />X STATEMENT OF BENEFICIAL USE OF GROUND WATER <br />AMENDMENT OF EXISTING RECORD <br />LATE REGISTRATION <br />AFFIDAVIT <br />PERMIT NUMBER 64684 LOCATION OF WELL <br />64685 <br />1-HE AFFAN7(S) Cotter Corporation Co,,,,ry Jefferson <br />whose mailing <br />address .s P. O. Box 352 NW y, of rti~ _SE ~. se[r~o„ 25 <br />C,ty Golden Colorado 80401 r_P. 2 S Req. _~_ W .6th P M <br />ta~•r[1 IIRr Now 5~ ~E co w <br />being duly sworn upon oath, deposes and says char he (they) is (are) the owner(s) of the well described hereon, the well .s <br />located as described above, at distances of 1810 feet from the SOllth secrron Irne and . 1405 feet from the <br />rwa.r. ~. aoor.r <br />EdSt section line; water From this well was first applied to a beneficial use for the purpose(s) described herein on the2lSt <br />~.~. a.:w ..[,. <br />day of Auqust lq 72 ~ the maximum sustained pumping rate of the well is 4 gallons per minute, the pumping <br />rare claimed hereby is - 4 gallons per minute; the total depth of the well is 42 Feet; the overage annual amount <br />commercial <br />of water to be diverted is 5 acre-feet; for which claim is hereby made for drinking and sanitary <br />facilities <br />purpose(s); the legal description of the land on which the water from rhos well .s used .s <br />SEi of Section 25, 725, R71W, 6th P.M., Jefferson C <br />which <br />acres are irrigated and which is illustrated on the map on the reverse side of this form; that this well was completed in <br />compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with law; he <br />(they) has (have) read the statements made hereon; knows the content thereof; and that the same are true of his (their) knowledge. <br />(COMPLETE REVERSE SIDE OF THIS FORM) <br />Signature(s) rte..---~ f~~ ~~'7 r.'.c C.: Lf-' <br />Subscribed and s~.vorn <br />to before me, on this 1.37'/1 day of 19 _y <br />i/ , <br />My Commission expires: My Commission expires 8(C~1 22r 198 <br />,a:.cr <br />\...11 +a ..w. woe uc <br />' II <br />ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO <br />PURSUANT TO THE FOLLOWING CONDITIONS: <br />FOR OFFICE US_ ONIY <br />ee„rr ease Ho <br />Prior. Mo Doy ~ Yr <br />D... _ Cry. <br />Sec. '/.. '/•. ' <br />'Nell Uae _ <br />Drat __ aOain _ Man D~a <br />O<rE 5T>TE EHGiHEER By <br />