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COLORA00 DIVISION OF WATcR RESOURCES +/ INSTRl1CTIONS FOR COM.PLE7ING PERMIT APPLICATION Please note that this form ..-ust he tomplet ed where applicable and typed or printed In black ink (for duolicacing purposes). Please Indicate a; the Cop, the purpose of the application by placing an (X) mark in t~ approprlace spaces. Application fees are not refundable. The following is a briar outline for completing the form. The Item number corresponds to thr. number on the application form, ITEM (1) APPL^ (CANT - Complete in full. (Copies of the permit and all correspondence will oe sent to this address unless otherwise requested), (2) LOCATION Of PROPOSED WILL - Complete each blank. The 1/4 of the I/4 section, section number, township ([wp) and range(rnc) each r.,ust be desicnated. (3) WATER USE AND WELL OATn - Glve: propcsed pur..ping rave, acre-feet (refer to Water Equivalent Tablc or. the bacR of the form), Irrigated acres if any, otherwise "none", proposed total depth, aquifer if known (;his can be sand, sand and gravel, sandstone, granite, etc, or the 5eological name), and owners well desiana;ion if any, such as name or number. GROUND WATER TO BE USED FOR: One er rcre of ;he uses must be indicated. HOUSEY.OLO USE ONLY msans solely for household purposes with no outside irritation of lawn or oarden. Oo not mark "DOMESTIC" for this use. DOMESTIC should be checked for household and/or lawn and garden irrigation of one acre or less. This can also include uss for watering of domestic animals. IRRIGATION should he checked when irriaating more than one acre. (4) DRILLER - Tnis should be completed in full if a driller has been selected, otherwise "licensed" or "self". All wells must be constructed by a driller .r licensed in the State of Colorado or by yourself with equipment owned and operated by you. (5) THE LOCATION OF THE PROPOSED WELL - The location of the well must Se indicated on the diagram by an "X". If the well is used for irrigation purposes the land area to be irrigated must be shaded or crosshatched in the diagram. (6) 'JELL LOCATION - The distance from the section lines "UST be given for all wells. Make surf this corresponds with the 1/L of the 1/4 section !ocation in Item (2). (7) TRACT -The number of acres should be given as accurately as possible. "Less than one" is Sufficient on small tracts of less than one zcre. Also, indicate if this is to be the only well on that given tract and the owner. (8) PROPOSED CASING ?ROGRAM - This is important info nation to [he Div isicn of Water Resources for evaluation of the application. The total depth should correspond with proposed depth stated in Item (3). ?least indicate any uncased interval anticipated and size of hole, Your well driller can help you with this item, if necessary. (9) FOR REPLACEMENT uELlS - Complete as indicated.• (1 O) LANG ON 4HICH "uR0UN0 WATER WILL BE USED - land owner's (s') name(s) must be indicated for ;he proposed well. The number of acres and legal description must be given for all proposed wells except for household, domestic or stock wells when located on a tract of land of less than thirty-five (35) ac: es. (I 1) DETAILED OESCAIPTION of the use of ground water: for Commercial, Industrial and Municipal wells this should give information such as number of people served, number of taps, use of the water area served, etc. Hcuseiwld and domestic walls must indicate type of disposal system. If other than septic tonic and leach field, explain how effluent will return to same stream system in which well it located. Use extra space if necessary. (12) 07HEA WATER RIGHTS - If any, pleasa indicate. (13) SIGNATUR -The application must be signed in hlack ink by applicant or his authorized agent. ' Contact a well driller for assistance if necessary.