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WRJ.S-Rev^'6 COLORADO DIVISION OF WATER RESOURCES <br />816 Centennial Bldp., 1313 Sherman St., Denver, Colorado 80203 <br />PERMIT APPLICATION FORM_ <br />7pliWt(on must ~~ ~ ~ / <br />complete where 1 1 A PERMIT TO USE GROUNp WATER (Ty <br />licable. Type or I XI q PERMIT TO CONSTRUCT A WELL <br />print in BLACK FOR: (Xl A PERMIT TO INSTALL A PUMP <br />INK. No overstrikes <br />or erasures unless ( )REPLACEMENT FOR NO. <br />initialed. ( )OTHER <br />WATER COURT CASE NO. <br /> <br />RECf11IED ~ <br /> ~ T. <br />G~~~ O1 '91 <br /> <br />':.i. .%t RGtOIJRCES m <br />m <br />,. ~~ ~o <br />Qn~ <br />/t-aC' s( 8-~9.9/ <br /> <br />~ W <br />m <br /> <br /> U <br />(1) APPLICANT -mailing address <br />NAME Julia Silva <br />STREET 13800 County Rd 21.4 <br />CITY Weston Co. 81091 <br />Isue•I tziol <br />TELEPHONE NO. (719) 868-3384 <br />(2) LOCATION OF PROPOSED WELL <br />County Las Amimas <br />NWa '/. of the NEa '.4. Section 1 2 <br />T,,,rp.33 S Rng. 68 W 6th F.M. <br />~N,51 iE.M'~ <br />WATER USE AND WELL DATA <br />Proposed maximum pumping rate Igpml 1 S <br />Average annual amount of ground water <br />to be appropriated lacre•feetl: 1 acre <br />Number of acres to be irrigated: -0- <br />Proposed total depth Ifeetl: 200 <br />Aquifer ground water is to be obtained from: <br />Trinidad sandstone <br />Owner's well designation <br />GROUND WATER TO BE USED FOR: <br />1 1 HOUSEHOLD USE ONLY <br />(X) DOMESTIC 111 <br />1 LIVESTOCK (2) <br />1 1 COMMERCIAL 141 <br />1 OTHER 191 <br />DETAIL THE USE ON BACK IN (11) <br />14) DRILLER <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMNti <br />N <br />~o <br />p m <br />Receipt No. ~~e ~ ~ ~ / r <br />Zi <br />Basin Dist. a <br />I <br />ti <br />NDITIONS OF APPROVAL m <br />m <br />This well shall be 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 />G <br />~ wl, <br />APPLICATION APPROVED <br />PERMIT NUMBER <br />DATE ISSUED <br />~ne Russell Sharpe I EXPIRATION DATE <br />eat -P !1 BOY 77 n 1 <br /> <br />City Trinidad CO. $1082 I (STATE ENGINEERI <br />ISU~eI (Z~ol <br />Telephone Nol 71 q l 8~ Lic. No. <br />no irrigation 101 <br />( I INDUSTRIAL 151 <br />)IRRIGATION (61 <br />1 MUNICIPAL 181 <br />BY /~ q <br />I.D. 02 COUNTY~° ~ J <br />