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.,,J J-n CV. ip <br />Application must <br />Complete where <br />lieade. Type or <br />int in BLACK <br />j,N~, No overstrike <br />or erasures unlaw <br />initiated. <br />.,v...,. •r.uu as,r w,V1Y VI CC/y1 Lrl f1CJ1JV11b CJ <br />818 Gnunnial &dg.,1313 SMrman St., Ilenrer, Colorado 80203 <br />PERMIT APPLICATION FORM <br />1 A PERMIT TO USE GROUNO WATER <br />1 A PERMIT TO CONSTRUCT A WELL <br />FOR: 1 ) A PERMIT TO INSTALL A PUMP <br />( )REPLACEMENT FOR NO. <br />( )OTHER None of the above <br />WATE31 COURT CASE N0. <br />.RECEIVED <br />AUG 2 6 1981 <br />IlthrER REtoURC~ <br />~[ trtCUlF(a <br />X014 <br />FOR OFFICE USE ONLY: 00 NOT WRITE IN THiS COLUMN <br />NAME WESTERN PAVING CONSTRUCTION CO. <br />STREET ;400 W. 64th Avetiue <br />y!OTy DENVER COLORADO 80221 <br />tsmq aul <br />'. TELEPHONENO._(303) 428 0800 <br />(2! iOCATION OF PROPOSED WELL <br />~sCounty WELD <br />X of tM - u, sections 16-20-; <br />p. 2 N, qrp, 68 W 6th p <br />iH,s ie.m <br />maximum pumpirq rate (gpm) NONE <br />k~ <br />.t~5 <br />~.__ <br />i isrr <br />erage annual amount of Bound mater NONE <br />be.epproprieted lave•faet): <br />of aaas to be irrigated: <br />NONE <br />topl depth (feet): 20' <br />ground water is to be obLinad from: Surface <br />~ :_s#,lwiw'cwelldesigwtionCottonwood Pit <br />~~'~ GROUND WATERIO BE USED FOR: <br />i <br />=~ !HOUSEHOLD USE ONLY • ra irrigation 10- <br />( - DOMESTIC Itl . ( )INDUSTRIAL 15! <br />( 1 LIVESTOCK 121 ( )IRRIGATION I6) <br />1 COMMERCIAL 141 ( - MUNICIPAL W) <br />1 IOTHER181_ NONE OF THE ABOVE <br />DETAIL THE USE: ON BACK IN (11) <br />(4) pRILLER <br />Receipt No. ~- / <br />Basin <br />Oist. <br />This well shall tte used in such a way as to cause <br />no material injury to existing water rights. The <br />iswanceof the permit does not assure the applicant <br />that n0 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 /> <br />APPLICATION APPROVED <br />PERMIT NUMBER <br />DATE ISSUED <br />Wrtu NONE <br />~~ <br />Gtv 1 ut•1 l o <br />Telephone Na Lic. No. <br />EXPIRATION PATE <br />(STATE ENGIN ER) <br />BY. <br />I.o. <br />couNrv <br /> <br />