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GWS-38A <br />I (we) <br />1. I(we) own real property described as <br />600 FOOT WELL SPACING STATEMENT <br />P.M., W~/Gt County, Colorado. We own the right and <br />easement to the following well(s): <br />Permit # 1/4 1/4 Sec. Twp. <br />v2.4 454-'? <br />2 <br />3 <br />in <br />the _ '/< of the '/<, Section _, Township ,Range <br />I (we) have been apprised that <br />present owners of a parcel of land in the <br />Actual <br />Distance from <br />Rng. N/S Sec. Line <br />ft. <br />ft. <br />ft. <br />Actual <br />Distance from <br />EIW Sec. Line <br />ft. <br />ft. <br />ft. <br />,the <br />'/. of the '/+, Section _, <br />Township ,Range P.M., desire to drill a new well or <br />extend the use of an existing well. I (we} also understand that the purpose of such <br />well is set forth in the well permit application, and that I (we) have reviewed the <br />application that was submitted to the State Engineer and receipted by him under <br />receipt no. <br />The proposed location for the subject well will be 600 feet or less from my (our) <br />welt. <br />4. By this statement I (we) am (are) spec~cally waiving any objection to the issuance <br />of a well permit for the subject well, as set forth in the referenced application, and <br />would request that permit issuance not be postponed or denied because of any <br />concerns by the Division or others that the proposed well will materially affect my <br />(our) well or water right. I (we) am {are) also specifically waiving my (our} right I <br />(we) may have to participate in a hearing before the State Engineer pursuant to <br />Section 37-90-137(2), C.R.S. <br />Dated this ~ day of ,br~a's'r Zpo? <br />. ,r7 ~ .~~ <br />''s, ~ <br />.^"'~ <br />r <br />state as follows: <br />as <br />