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COLORADO DIVISION OF WATER RESOURCES <br />DEPARTMEN•P OF N.ITURAL RESOURCES <br />1313 SHERNIAN ST., RM. 828, DENVER CO 80203 <br />phone -info: 13031 8B&3587 main: (303) 886-3587 <br />RESIDENTIAL •„~Y.~~.,,.~.,..e,~.rnnm.,wy~•aw.~..r~na~ Water Well Permit Application <br />e...:_...:.........«........s,...,........u~a.... w,.... Must he mmaleLed m black ink or tvead <br />S. APPLICANT INFORMATION 6. USE OF WELL Ided: a entry ar errtriasl <br />.w....-. s« a,.weaon. a d.e~. r,.t.l eer wn~ you m.y arah - <br />Mr. & Mrs. Charles Richard Hall ~ A• Ordinary h°"aefT°Id us° 1^ o"a single-temih dwd7in9 <br /> (L11g avtsFe(s asel <br />r~'"'""~S"'S~6 7 6/ENC « ~ g. Ordinary household uas In 7 m 3 sinde-kindly <br />~Re~e• i~-~ae~r}5}B aww~: <br /> Number of dwetlinga: 1 <br />~T re. """ LKJ Hame gardeMawn irtipatlen, not to exceed 7 acre: <br />Lon ont O area brigated 1 0 sq. RX'Xaae <br />TWMw twit O,rW wwrl ® Domesdc ardrnal Weterk+g -(norrcommaraall <br />_ <br />Z TYPE Of APPLICATION Idmdc applicable boxles)1 d C. Livestock waterin len lppard <br />O Construct new wdl O Use existlrp well 7. WELL DATA <br />~Replaee exiaWtg weg ~Changellrterease flee rr.r pw+ww~.. wr..w.rwur.w <br /> <br />f3 Qunpe feourcel awiter ^ ReappEpderyayu.a p..+n 4 <br />W"' 0.5 aero•roai <br />^ Other. T.r M pM~ <br />3. REFER TO lit a eabiel: 880 t«t Dakota Sandstone <br />w.tr aauT O... ~ r.,ndrs 8. TYPE OF RESR)ENTIAL S EWAGE SYSTEM <br />n/a 24324 Septic tank /absorption leach field <br />v«sr s a ~..movn.aam.,e e O Central system <br />n/a -VE MH-35268 piaoiat nano: <br />wr n~.> i O Vauk <br /> Lawdon sswsw a i» lyd.d m: <br />4. LOCATION OF WELL ^ Other (seuoh et rNSd <br />c°"nT m°'°'ra""°' ourrar 9: PROPOSED WELL DRILLER 1 octal) <br />Boulder 14 34 "'"' "°°'°"" <br />..oeon TawrWpR«s e.,ra. Eorw rn,+.rr.r., Ingram Drilling, Inc. 1099 <br />28 3 ~I p 70 p ~(j 6th 10. SIGNATURE of app8earnlsl or authoraed agem <br />ta.rMn ee v..s nom'o6'bn a,.. fie makkp of taLta statements heroin edratlttrtes per)try <br />190 e. hrn ^ N ~ 8 48 0 h f,om YI E O w In ~ xcond degree. which tr pde u a Gass t mis- <br />ty" r.e.,.'r~, ~ rn"` °""' ~'°~"".~ r r~YrW demeanor pursuant to C.R.S. 244-/ 041131/al. I have read <br />n/a the statemaro herein, know the eomarts thereof and state <br />P.,,r~.e..w.r.+r-..,...w ~..i.,n.n.rw.er,r. wr <br />- that they arE truemmy knowbdge. <br />/.$ <br />~ feet 7V kl direction rrRr.dr.~.a..r <br />5: TRACT ON WHICH WELL WILL BE LOCATED <br />A. Yaw uwt dwelt arp of en roaowbe - sea ioerator~ Tu. o.e. <br />D sldxrWaien: Name 2/12 /9 9 <br />Lot no. Biodt m. FgingMdt OPTIONAL INFORMATION <br />^ Caunty exempden lmseh oovY or eounry approval lr twnray) ueos ~,r.... oynl wr. wm..r. <br />Name/no. Tract no. <br />Mining tYaim laeaeh copy of eoN ar na~yl Orfioo We Ody <br />Name/no. DIV <br />Other l.ae~ yaw a..egptgn m ~ppeoNoo) <br />Dover l <br />tter <br />. <br />e <br />~ _ _ CO <br />a STATE PARCH: <br />IDt tepaeo.e: . WD <br />C. I.m.. ^ V.ee D. M yew ew erns of etia PbPrtYT <br />1 XdYES D NO is no - ,« d.cn'4e Lrr.) BA <br />E Wil dds ba tha only weg.m this tract) <br />®YES ~ NO M etltor woes an an tlY eroet - w dotaiW Mel USE MD <br />Form OWS-is (I1/9i) <br />