PERMFILE100451

• Permit No: M1982131
• IBM Index Class Name: Permit File
• Doc Date: 7/27/1982
• Doc Name: MEMO BUCKLEN EQUIPMENT CO APPLICATION FOR MINING RECLAMATION PN 81-131
• From: DWR
• To: MLR
• Media Type: D
• Archive: No

WRJ'S-Rev. 76 CDL~ADD DIVISION OF WATER RESOU~
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
PERMIT APPLICATION FORM

Application must _
be complete where ( ) A PERMIT TO USE GROUND WATER
applicable. Type or ( I A PERMIT TO CONSTRUCT A WELL
print in BLACK FOR: ( ) A PERMIT TO INSTALL A PUMP
INK. No overstrikes
or erasures unless ( I REPLACEMENT FOR N0.
initialed. ( )OTHER
WATER COURT CASE N0.
(11 APPLICANT -mailing address
NAME
~ STREET
CITY
' (State) (Zip)
TELEPHONE N0.
(2) LOCATION OF PROPOSED WELL
' County
'/, of the '/., Section
Twp _, Rng. P.M.
W.S IE 1VI
131 WATER USE AND WELL DATA
Proposed maximum pumping rate Igpm1 -_
Average annual amount of ground water
to be appropriated (acre~feetl:
Number of acres to be urigated: _
Proposed total depth (feet):
Aquifer ground water is to be obtained from:
'~ Owner's well designation
i GROUND WATER TO BE USED FOR:
I ( I HOUSEHOLD USE ONLY - no irrigation 101
~ ( 1 DOMESTIC 111 ( 1 INDUSTRIAL 161
1 1 LIVESTOCK 121 1 1 IRRIGATION 161
1 COMMERCIAL (41 ( 1 MUNICIPAL IS)
1 I OTHER 191
DETAIL THE USE ON BACK IN 1111
141 DRILLER
Name
Streei
City
(Sla\e) (Zip)
Telephone No. Lic. Na.
~ FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN
Receipt No.
Basin
Dist
CONDITIONS OF APPROVAL
This well shall be used in such a way as to cause
no material injury to existing water rights. The
issuance of the permit does not assure the applicant
that no injury will occur to another vested water
right or preclude another owner of a vested water
right from seeking relief in a civil court action.
APPLICATION APPROVED
PERMIT NUMBER _
DATE ISSUED
EXPIRATION DATE
(STATE ENGINEER)
BY
I.D
COUNTY _„