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S= <br />WRJ-S~Rev. J6 C~RADD DIVISION OF WATER RESO~CES <br />818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br /> PERMIT APPLICATION FORM <br />Application must <br />be complete where I X) A PERMIT TO USE GROUND WATER <br />applicable. Type or I X) A PERMIT TO CONSTRUCT A WELL <br />print in BLACK FOR: 1 X1 A PERMIT TO INSTALL A PUMP <br />INK. N o overstri kes <br />or eerasures unless ( I REPLACEMENT FOR N0. <br />initialed. ( IOTHER <br /> WATER COURT CASE N0. ~ - 5122 <br />(1 <br />address <br />NAME E1mPS and Helen Andrews <br />STREET 243)'6 C. Street NorthlJest <br />CITY Greeley, CO 8G631 <br />tsurol tncl <br />TELEPHONE NO. ~ 303' .35"1-ic.44 <br />(2) LOCATION OF PROPOSED WELL <br />County_ <br />of '/. of the SF '/., Section <br />Twp. 6 N , Rnq. 66 w` 6th P.M. <br />iN.sl IE.Wi <br />(3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate (gpm) 4t1 <br />Average annual amount of ground water 21 <br />to be appropriated lacre-teed: <br />Number of acres to be Irrigated: ~/ or less <br />Proposed total depth Ifeetl: ~ r <br />Aquifer ground water is to be obtained from <br />Owner's well designation <br />GROUND WATER TO BE USED FOR: <br />( )HOUSEHOLD USE ONLY ~ no irrigation 101 <br />1 DOMESTIC (11 ( 1 INDUSTRIAL 151 <br />1 LIVESTOCK 12) (XI IRRIGATION (61 <br />I COMMERCIAL 141 ~ ( 1 MUNICIPAL 181 <br />I OTHER (91 <br />DETAIL THE USE ON BACK IN (11) <br />(41 DRILLER <br />Name Lesh Drilling, Inc. <br />Street )'•0• Box 56 <br />Gty Ault CO 8'161• <br />tstaet Iz~o1 <br />~3'13~ 834-2868 zl <br />elephone No. Lic. No. <br />rleld <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />Receipt No <br />Basin <br />Dist. <br />ONDITIONS OF APPROVAL <br />This well shall be used in such a way as to cause <br />no material injury to existing water rights. The <br />issuance of the permit does not assure the applicant <br />that no injury will occur to another vested water <br />right or preclude another owner of a vested water <br />right from seeking relief in a civil court action. <br />~ ~ <br />I~ ° <br />c~ a <br />In <br />APPLICATION R <br />PERMIT NUMBER <br />DATE ISSUED <br />EXPIRATION DAT <br />BV <br />I.D <br />• <br />m <br />'1 <br />ny <br />o W <br />Q <br />y D e <br />;zo <br />W <br />O"Do <br />m <br />aW30 <br />~~_~ <br />~Wrnw <br />W U ~ <br />~QmQ <br />W~NU' <br />~I C <br />fo <br />\~ I <br />~~, <br />£ a <br />0 <br />m` <br />ao <br />z <br />~4 S n° <br />'c r5t~ <br />~dcU <br />_p~N~ <br />$~~~ <br />x <br />q ~~ <br />y\' <br />l <br />M <br />O <br />O <br />n., <br />s <br />r r1 <br />1 <br />M <br />l7 <br />O <br />O <br />I] <br />