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Rus 18 2006 8:31]RM NP LRSERJET FRX <br />GWS-38 800 FOOT WEl_t_ SPACING STATEMENT <br />I (we) Randall J. Panouncz state as tolbws. <br />1, 1(we) own real property described as - in <br />the '/. 01 the NE %, Section 25 ,Township 2N Range 67W <br />6'" P. M., Weld County, Colorado. We own the right and <br />Fasemeni to the following wells: <br />Permit # 114 %. 'Sec. Twp. Rng. Actual Distance Actual Distance <br />from N!S Sec. Line from EJtN Sec. <br />line <br />15J913 Unknown ft. Unknown ft <br />_~ ~ ft. R <br />,_ it. ft <br />2. I (we) have been apprised that Nonhem Colo2do Constructors ,the <br />present owners of a parcel of land In the ~ Y. of the SE '!., Section 24 <br />Township 2N , Range 67W 6'" P.M., desires to drill a new welt or <br />extent the use of an existing well. I (vre) also understand loaf the purpose flf Such <br />applicatbn that was submitted to the State Engineer and receipted by him under <br />receipt no. To be re-submitted <br />3. The proposed locatbn for the subject well wtll ba 800 feet or less from my (our) well. <br />4. BY this statement I (we) am (are) specifically waiving any objection to the issuance of a <br />wort permit forlhe sub)ect well, a8 set forth in the referenced application, and woNd <br />request that permit issuance not be postponed or denied because of any concerns by the <br />Dlvtabn or others that the proposed well will materially affect my (our) wall or water right. 1 <br />(we) am (are) also specifically waiving my (our) right 1(we) may have to participate In a <br />hearing before the State Engineer pursuant to Section 37-90.137(2). C.R.S. <br />p.l <br />Dated this Gl ' ~ ~ day of August 2006 n <br />Signature: ~~ y~~L/ y -~~t ~~ <br />Title: Ot!~Y~ ~ <br />