Laserfiche WebLink
AFF1llAV I'r <br />STATE OF COLORADO ) <br />COUNTY OF ) <br />I(we) <br />being first sworn under oath, state as follows: <br />1. I(we) own real property described as <br />in the 1/4 of the 1/4,Section , <br />Township Range P.M., <br />County, Colorado. Located on our property are the following well(s): <br />(USE PERMIT NO. IF KNOWN) <br />2. I(we) have been apprised that , <br />the present owners of a parcel of land in the 1/4 of the 1/4, <br />Section _, Township ,Range , P.M., <br />desire to drill a new well(s) or the extend the use of an existing <br />well(s). I(we) also understand that the purpose of such well(s) is to <br />and I(we) have <br />reviewed the application(s) that were submitted to the State Engineer <br />and receipted by him under receipt no(s). <br />3. The proposed location(s) for the <br />well(s) will be less than 600 feet from one or more of my(our) wells. <br />4. I(we) have no objection to the Division of Water Resources issuing a <br />well permit(s) to as <br />proposed in the referenced application(s) and would request that permit <br />issuance not be postponed or denied because of any concerns by the <br />Division or others that the proposed well(s) will materially affect <br />my (our) well(s) or water right(s). <br />5. By this affidavit I(we) are specifically waiving any objection to the <br />issuance of a well permit(s) to <br />pursuant to the request as set forth in the referenced application(s). <br />I(we) also specifically waive any right (I)we may have to participate <br />in a hearing before the State Engineer pursuant to Section 37-90-137(2), <br />C.R.S. <br />Dated this day of , 19 <br />Subscribed and sworn to before me this <br />WITNESS my hand and official seal. <br />My commission expires: <br />day of <br />19 <br />Notary <br />