REV02769

• Permit No: C1981010
• IBM Index Class Name: Revision
• Doc Name: PERMIT APPLICAITON FORM
• Type & Sequence: MR115
• Media Type: D
• Archive: No

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(5} THE LOCATION OF ~ PROPOSED WELL and the area on
which the water will be us ust be indicated on the diagram below.
Use the CENTER SECTION I1 section, 640 aces) !w the well location.
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11 MILE, 5280 FEET
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The scale of the diagram is 2 inches = 1 mile
Each small square represents 40 acres.
WATER EQUIVALENTS TABLE IRountled F~gur esl
An acre-loaf covers 7 acre o/ land 1 loot deep
1 cable foot per Seto ntl Ictsl ...449 gallons per minute I9pm1
A (amply of 5 will tea ulre dppro •'mat ely t acre-loot of wafer per year.
t acre~loor ...47.560 cubic leer ...325.900 gaiio~s.
1,000 gam ou mped con hnupusly Ipr one tlay prOtluces 4 42 acre leer
(10) LAND ON VJHICH GROUND WATER WILL BE USED:
SHE WELL MUST BE LOCATED BELONJ
y distances fro-. section lines.
1, 200 ft, }tom North •sec. line
tnortn ar soutnl
2, 600 ft. from West sec. Tine
feast or west{ i
LOT BLOCK FILING e
SUBDIVISION
(7) TRACT ON WHICH WELL WILL BE
LOCATED Owner:_ Trapper Minir.e I-.
No. of acres 11+7 • 76 .Will this be '
the only well on this tract? NO
(8)PROPOSED CASING PROGRAM
Plain Casing
6 in. from 0 ft. to 1 , 200 ft.
6 in. from 1 .000 ft. to 1 .200 ft '
Perforated casing
in. from ft. to ft.
in. from ft. to ft.
(9) FOR REPLACEMENT WELLSgivedBtance '
and direction from old well and plans for pluggino
it:
Well will be located approximately 100'
east of esisti ng well. Exis[ine yell wi"_:
be plucg.ed ace ordin,, to "fined Land Recla-
mation reculations and Well Contractor's
rules and regulations.
O~sner(sl: '."ra pp'r '9ininc I c No. o(acres: ;46.72
Legal description: S/2 of Lot 2; S/2 of Lot 3; SE/4 of Lot 4~ ~/' of Lot 5: Lot 6; Lo[ 7 of Section 27.
(11) DETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal
rystem to be used., Water will be used for demcst is and ir.dus;r ial purposes. Sepcic di scowl system is
installed for domestic
(12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numtlers.
Type or right
Used for lpurpose)
Description of land on tvhlch used
22140-F Pi[ Dewar eri nc T-Gar*inl
CiS.71-F uur.r.,_c '_cal >:in,= L~:~.: :.
W-fi37-75 Industrial "
(13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS
TRUE TO THE BEST OF HIS KNOWLEDGE.
SIGNATURE OF APPL /CANTIS!
Use additional sheets of paper if more space is required.