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• ~ L ~ _ t j <br />wR~.s-aev. 75 COLORljDO DIVISION OF WATER RESOURCES R~CE~ 1/EJ <br />818 CentennialBldg., 1313 Sherman St., Denver, Colorado 80203 <br />-- APR2 ~J 1SS7 <br />PERMIT. APPLICATION FORM <br />Application must ~~l.ST:R 6R+~: t~; c:. <br />be complete where ( ) A PERMIT TO USE GROUND WATER ~',;,IE•;H~:ti:EG <br />applicable. Type or (XI A PERMIT TO CONSTRUCT A WELL D4-~a-B' 1=:1~ F' ~.p, <br />print in BLACK FOR: ( 1 A PERMIT TO INSTALL A PUMP ~ ~7 ~~,,fbl <br />INK. No overstrikes 03~i72 5t7.~J <br />~ <br />or erasures unless ( )REPLACEMENT FOR N0. <br /> <br />f <br />` I i` <br />f'~3 <br />initialed. ( )OTHER V,i <br />t <br />.• <br /> WATER COURT CASE N0. TiL _l~.~J <br /> C?,:pUE 50.00 <br />(1) APPLICANT • mailing address <br />NAME Gold Hill Ventures <br />STREET PO Box 1523 <br />CITY LOn mont, CO 805D1 <br />Isialel tzlal <br />TELEPHONE NO. 449-7746 <br />(2) LOCATION OF PROPOSED WELL <br />County Boulder <br />SE '/, of the NW '/., Section 12 <br />Twp. 1 N Rng. 72 6'7 Gth P.M. <br />tN.51 ~E WI <br />(3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate Igpml SaItlp ley Only <br />Average annual amount of ground water <br />to be appropriated (acre~feetl: 0 <br />Number of acres to be irrigated: 0 <br />Proposed total depth (feed: 60 <br />Aquifer ground water is to be obtained from: <br />Granite <br />Owner's well designation ~ 1 <br />GROUND WATER TO BE USED FOR: <br />( )HOUSEHOLD USE ONLY - no irrigation (01 <br />( 1 DOMESTIC (11 ( )INDUSTRIAL 15) <br />( 1 LIVESTOCK (21 ( )IRRIGATION 46) <br />( 1 COMMERCIAL 141 ( 1 MUNICIPAL (el <br />FOR OFFICE USE ON LY~~rL?0 NOT WR'ITE~1N THIS COLUMN <br />IT"i <br />7yd~sa'=L-~ 7a4a7s <br />Receipt No. / <br />Basin <br />Dist. <br />CONDITIONS OF APPROVAL <br />This well shall he used in such a way as to cause <br />no material injury to existing water rights. The <br />issuance of the permit does not assure 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 action. <br />1) APPROVED PURSUANT TO C.R.S. 37-90-137(2) TO <br />SATISFY THE PERMIT REQUIREMENTS OF C.R.S. <br />37-90-138(3) USE OF THIS WELL IS LIMITED TO <br />MONITORING WATER LEVET,S AND/OR WATER QUALITY <br />SAMPLING. <br />2) THIS WELL MUST BE EQUIPPED WITH A LOCKING <br />CAP OR SEAL TO PREVENT WELL CONTAMINATION OR <br />POSSIBLE HAZARDS AS AN OPEN WELL. THE WELL <br />MUST BE KEPT LOCKED AT ALL TIMES EXCEPT DURING <br />TER LEVEL MEASUREMENTS AND <br />ALYSES SHALL BE MATNTAINED BY <br />ND SUBMITTED TO THE DIVISION OF <br />4) UPON CONCLUSION OF THE MONITORING PROGRAM <br />THE APPLICANT SHALL PLUG AND ABANDON THIS WE~,L <br />IN ACCORDANCE WITH THE RULES AND REGULATIONS <br />FOR WATER WELL CONSTRUCTION AND PUMP INSTALLA- <br />TION CONTRACTORS. <br />5) THE OWNER SHALL MARK THE WELL IN A CONSPICU- <br />OUS PLACE WITH APPROPRIATE WELL PERMIT NUMBER <br />AND NAME OF THE AQUIFER. HE SHALL TARE <br />NECESSARY MEANS AND PRECAUTIONS TO PRESERVF, <br />THESE MARKINGS. t/~ y f~Y~~? <br />{ XI OTHER 191 Monitoring ~ APPLICATION APPROVED <br />DETAIL THE USE ON BACK IN (11) <br />(4) DRILLER <br />Name GROUND WATER SYSTEMS, INC. <br />Street 4599 N. Broadway ~ ..,, <br />PERMIT NUMBER 31. UU J ~~~ <br />DATE ISSUED APR 22 1987 <br />EXPIRATION DATE APR 2 31988 <br />O,ty Boulder, CO 80501 <br />t5ute) IZm) <br /> <br />T~li,.,~ __4 h?_L'n?~ ... ,... _ o~~ I BY\ 1_\~~+?..C l°=\\\ .\_~'~{V. •Y~J'\-\~-]'I~s <br />