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' ~t-t>~ <br />~. <br />Application must <br />he complete where <br />applicable. Type or <br />print in BLACK <br />INK. No overstrikes <br />or erasures unless <br />initialed. <br />NAME <br />COLORADO DIVISION OF WATER RESOURCES <br />300 Columbine Bidg., 1845 Sherman St., Denver. Colorado 80203 <br />PERMIT APPLICATION FORM <br />( ,) A•PERMIT TO USE GROUND WATER <br />( X) A PERMIT TO CONSTRUCT A WELL <br />FOR: (X 1 A PE RMIT TO I NSTALL A PUMP <br />1 REPLACEMENT FOR NO. <br />)OTHER <br />WATER COURT CASE NO.. <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS <br />STREET .YSSd Lr)tl/.Il CrAr1' Hd .23 <br />CITY.LEf'C¢~feN LtA ~iO Sd4x1 <br />lsute) RIP) <br />TELEPHONE NO. L•S'9~a8'.t.2 <br />LOCATION OF PROPOSED WELL <br />count ~ wr6J - <br />'G of the 'r/'h1"~ coon 19 <br />TwP.~_ ~.Rng._LZ ~. _-__~-P.M <br />._.... _ ___ (N.S) _ _ _ . _ _ (E.wl <br />Proposed (haximum pumping rata Igpml <br />Average annual amoum bf ground water C <br />to be appropriated (acre•feed: ~ 7 <br />Number of acres to be irrigated: A~~~ / <br />Proposed total depth (feed: ~~0 =' ~~ <br />Aquifer ground water is to he obtained from: <br />~OX ~i / I.1Is <br />Owner's well designation Q O.UES~i e <br />GROUND WATER TO BE USED FOR: <br />( )HOUSEHOLD USE ONLY?- no irrigation (01 <br />IX) DOMESTIC Iil ( )INDUSTRIAL 15) <br />( 1 LIVESTOCK 12) ( I IRRIGATION 161 <br />1 1 COMMERCIAL (4) ( )MUNICIPAL 181 <br />( )OTHER 191 <br />DETAIL THE USE ON BACK IN (11) <br />(4) DRIL ER <br />Name CJL DYF. Y'S ep~/NAr ENO <br />street ?^tls / wFl. ~ Ce :Pd .~/ <br />City ~f -/vv ~a~.1/ Gt01+d 8068! <br />(State RIP) <br />Telephone No. SS~`J1 y~ Lic, No. Sri <br />I.D. /-~~ COUNTY <br />c~ <br />l <br />`. <br />Receipt NO, pZ8 / <br />Basin Dist. <br />APtt05'78 ; <br />MATER g~ag,~.' 1 <br />Q~j' STATE ENGIREER WP1Eg <br />l t--~ ~W. SIPTE <br />.t. <br />CONDITIONS OF APPROVAL <br />This well shall be used in wch a way as to cause <br />no material injury to existing water rights. The <br />issuance of the permit does not aswre the applicant <br />that no injury will occur to another vested water <br />right or preclude another owner of a vested water <br />right from seeking relief in a civil court actjon. <br />- h plaU (na>•peTforstett) casings ltntil ~iroimd <br />tlown to a minimum depth o4 580 fit <br />ptoparyseeled t~oy~pryev~e~nt~the- pumpttti< a <br />. ~ .af'ltibtA>!t'ylldl~.Cl~t m <br />APPROVED FOR HOUSEHOLD' USE ONLY,'FOR ONE <br />(1) SINGLE FAMILY DWELLING AND NOT TO BE <br />USED TOR IRRIGATION. THE RETURN F10W FROM <br />THE USE OF THIS WELL MUST BE RETURNED TO <br />THE SAME STREAM SYSTEM IN WHICH THE WELL <br />IS LOCATED. ~ 4 <br />APPLICATION APPROVED <br />PERMIfi.NUMBER 9`7613 <br />DATE ISSUED APR 171978 <br />EXPIRATION DATE APR 171980'. <br />G . <br />.a~ (STATE ENGINEER) <br />BY <br />