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.,,.,DORADO DNIS~ OF WATER RESOURCES FIELD ~PEC710N REPORT <br />p/ease complete this /onn in INK <br />ON. ~ WD b 3 app!. receipt no(s). <br />DATE OF INSPECTION: 4 -) q - ~I ~" <br />APPUCrwr. E L M ~ R A N 1>REI.<15 person contacted i1 not applicant <br />ADDRESS: r~~o ~I O C S T /U W w.c. name s phone #: .SHAW Rl NoF~ <br />GRE~LEy ~ Co x'063/ 303 - aa~ ~ 330 3 <br />pnone: ~n ~ - 353 - /04q <br />EXISTING WELL LOCATION: ,, I /- , / <br />1/4, ~ 1/4, Sec. ~, Twp. 6 ~" , Rrg. ty 6 ~/ , ~7_ P.M.; <br />DIST. /o U D Lrom N~Jine, ~_lrom~W sec.line; County (,l FG1~ <br />(d rep!, give disc & dir. to new well site - ,S ~ E/9.5 T ) <br />cinle type of etasstirg well KILLED, RAND DUG, SPRING WELL, GALLERY WELL, GRAVEL PIT OTHER <br />how marry other wells are located on this parcel? 1 use? ! R R I G f~-T(O ~ <br />are they registered? permiUcase #(s)7 I,()OL F I~)t;LL rUO. nZ 1A) ~ ~/off 01 <br />EST. DATE WELL CONSTRUCTED 19 5 ~ DATE OF FIRST USE l `l,S~ EST. PUMPING RATE ~/ O gpm <br />TOTAL # OF ACRES IN THIS TRACT/PARCEL ~ ACRES <br />additional subd/paricel irtlo.: <br />USE OF WELL <br />household use in Vindicate how marryg single family dwelling(s) <br />watering of poultry and/or domestic animals rdomestlc animals' would inGude a few cows, horses, etc.) <br />watering of livestxk on a farm or ranch - approx how marry head? <br />is this a feed lot? ;how marry head? <br />(rt is important to specify estimated historic lawn/garden irr.) in. square leeUacre of lawn and/or garden <br />fire protection <br />commercial -drinking & san. only! (write detaiis in 'comments' section) <br />other (write details in 'comments' section) <br />yes l no WERE THE USES CHECKED ABOVE IN1TlATED PRIOR TO MAY 8, 1972? <br />NOTE: IF ANY CHANGE IN THE HISTORIC USE OF THIS WELL HAS OCCURRED SlN <br />in Nre 'comments' section oI this form <br />(i/ completing inspection for NON-EXEMPT USES, use comments section below ~nGude case #, # acres in. it applicable, etc.)) <br />signed : ~~.c~ dated: ~ /o~oZ /~ <br />additional comments andlor information: _[r;ED R) L L FD ~' h In L F u )ELL ~ )D l ~ C¢~SE <br />- <br />0 <br />EMEP.6EN~- <br />~ER~~(a sT oN ~-z2-lgg4~ I:45Prvi. APPLic~~T <br />more room for comments on the back <br />NI+S /8 MoTHEiP cow5~ (~ NEccJt3ok'rU CI9LUE5 ~9n1D 113uLL on) TNlS PA~k'E. <br />NcEDS A REDiF1LL To RE ~}-ISLE `TO o~lA~iNTAi~ 1~f5 L1~F5%OCIr NER~, <br />