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^� « -M <br /> COLC '.DO DIVISION OF WATER RESOURC REC IVED <br /> 818 Center....al Bldg., 1313 Sherman St., Denver, Colorado 80203 <br /> I <br /> -PERMIT APPLICATION FORM <br /> Application must <br /> tie complete where PERMIT TO USE GROUNDWATER <br /> pplicable. Type or (�1 C ) A PERMIT TO CONSTRUCT A WELL <br /> ' print in BL `w 1r'(` J PPP999Rt ( 1 A PERMIT TO INSTALL A PUMP I�,Oa <br /> INK. No ov r \� ^""' FLl 00 <br /> or erasure u I SSS • 1 1 REPLACEMENT FOR NO. <br /> initialed. 1 I OTHER �_ ;�•rl] <br /> ' WATER COURT CASE NO. <br /> (1) APPLICANT - mailing address FOR OFFICE USE ONLY-: b0 N477 h'e2IN THIS COLUMN <br /> .T;' <br /> NAME <br /> Gold Hill. Ventures Receipt No. � ' t_L-1 I <br /> STREET PO BOX 1523 Basin Dist. <br /> ' CITY Longmont, CO 80501 <br /> tstat.1 (Zip) CONDITIONS OF APPROVAL <br /> TELEPHONE NO. 449-7746 This well shall be used in such a way as to cause <br /> no material injury to existing water rights. The <br /> (2) LOCATION OF PROPOSED WELL 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 /> ' County Boulder right from seeking relief in a civil court action. <br /> 1) APPROVED PURSUANT TO C.R.S. 37-90-137(2) TO <br /> SE of the NW G, Section 12 SATISFY THE PERMIT REQUIREMENTS OF C.R.S. <br /> 37-90-138(3) . USE OF THIS WRLL IS LIMITED TO <br /> ' Twp. 1 IL. Rng, 72 t7 6th P.M, MONITORING WATER LEVELS AND/OR WATER QUALITY <br /> i N.& ie.wi ' SAMPLING. <br /> (3) WATER USE AND WELL DATA 2) THIS WELL MUST BE EQUIPPED WITH A LOCKING <br /> CAP OR SEAL TO PREVENT WELL CONTAMINATION OR <br /> ' POSSIBLE <br /> PTALEATNIMESCPMUSTKOCKD ALLTIM EXC WELL <br /> EPT DURING <br /> uposed maximum pumping rate (gpm) samples only SAMPLING OR MEASURING. <br /> 3) RECORDS OF WATER LEVEL MEASUREMENTS AND <br /> Average annual amount of ground water WATER QUALITY ANALYSES SHALL BE MAINTAINED BY <br /> ' to be appropriated (acre-feet): 0 THE WELL OWNER AND SUBMITTED TO THE DIVISION OF <br /> WATER RESOURCES UPON REQUEST. <br /> Number of acres to be irrigated: 0 4) UPON CONCLUSION OF THE MONITORING PROGRAM, <br /> THE APPLICANT SHALL PLUG AND ABANDON THIS WELL <br /> ' 60 IN ACCORDANCE WITH THE, RULES AND REGULATIONS <br /> Proposed total depth (feet): FOR WATER WELL CONSTRUCTION AND PUMP INSTALLA— <br /> TION CONTRACTORS. <br /> Aquifer ground water is to be obtained from: 5) THE OWNER SHALL MARK THE WELL IN A CONSPICU— <br /> OUS PLACE WITH APPROPRIATE WELL PERMIT NUMBER <br /> Granite AND NAME OF THE AQUIFER. HE SHALL TAKE <br /> NECESSARY MEANS AND PRECAUTIONS TO PRESERVE <br /> Owner's well designation n 2 THESE MARKINGS. <br /> GROUND WATER TO BE USED FOR: 1 <br /> ' ( 1 HOUSEHOLD USE ONLY - no irrigation (0) <br /> I ) DOMESTIC (1) 1 1 INDUSTRIAL (5) <br /> ( I LIVESTOCK 12) ( ) IRRIGATION (6) <br /> ' ( 1 COMMERCIAL (4) 1 I MUNICIPAL (8) <br /> I X) OTHER (9) Monf n ; nQ APPLICATION APPROVED <br /> DETAIL THE USE ON BACK IN 011 <br /> PERMIT NUMBER 31662 -M <br /> (4) DRILLIER DATE ISSUED APR 221987 <br /> Name GROUND WATER SYSTEMS , INC. EXPIRATION DATE APR 2 31938 <br /> 4599 N . Broadway r, <br /> 'City Boulder CO 80302 TATE GIVE RI <br /> cs ,ul t col \ <br /> o gY 11 <br /> 'Telephone No 542-4083 Lic. No. 63 — — <br />