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.~ <br />-5- <br />UU~Ur2AUU ?JAfu2 LA.JS <br />Tne pennittez is zncourayed to contact the Mate engineer, wiU~ reyar <br />administration of water rights, and uie Colorauu Jdp3rCtl12nC of Healtn <br />tnz discharge ur pollutants into the waters of thz State. Violation <br />l~~.us could rzsult in znfdrezmenC actions [aKen by the Stacz engineer <br />Jzparunent of Hzalth. <br />dUUII'lUiJAL [iJrUkWTiuN <br />'finis space can oz referenced fur furtner information of any of the it <br /> <br /> <br />o the <br />witn regard to <br />f Colurado water <br />nd/or the Colorado <br /> <br /> <br />ms on this form. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />To the best of <br />and correct. <br />Date: ~~ _ my <br /> <br />~ knowledge, all <br /> <br />C~ '~>T the infornation presented in this ap <br />II <br />dy: L.~~~/l lication is true <br /> _ <br />n~~L~ <br /> <br />(Rev. 9/33) <br />Uuc. No. 540 itle ~~ , , r, <br />~~~~U ~~r~A <br />~-T1 ~J <br />