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COLOR,jDO DIVISION OF WATER RESOURCES RECEIVED <br /> ' 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 rr <br /> PERMIT APPLICATION FORM <br /> Application must +a'=� �' •.: <br /> be complete where 1 ) A PERMIT TO USE GROUND WATER <br /> applicable. Type or ( )0 A PERMIT TO CONSTRUCT A WELL 0+=0-87 1=:1`; r wA <br /> print in BLACK FOR: ( 1 A PERMIT TO INSTALL A PUMP <br /> INK Nooverstrikes 03:+7' C,O C.] <br /> ' or erasures unless ( ) REPLACE1v1ENT FOR NO. <br /> initialed. ( ) OTHER a.+'nce FJO..� <br /> WATER COURT CASE NO. L =0.00 <br /> C?_'U_ 011 <br /> ' (1) APPLICANT - mailing address FOR OFFICE USE ONLYCJIbO NOT WR`fyt 1N THIS COLUMN <br /> ITh <br /> NAME Gold Hill Ventures Receipt No. 7yd/j-SCL-1I 7A4275 <br /> ' STREET PO BOX 1523 Basin Dist. <br /> CITY Longmont . (Slate) 8t05)O1 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 /> ' SE '/. of the NW %, Section 12 <br /> 1) APPROVED PURSUANT TO C.R.S. 37-90-137(2) TO <br /> Twp. 1 N. Rng. 72 W 6thP.M. SATISFY THE PERMIT REQUIREMENTS OF C.R.S. <br /> ' 'N.$) tE.M 37-90-138(3)_ USE OF THIS WELL IS LIMITED TO <br /> 3) WATER USE AND WELL DATA MONITORING WATER LEVELS AND/OR WATER QUALITY <br /> SAMPLING. <br /> 2) THIS WELL MUST BE EQUIPPED WITH A LOCKING <br /> CAP OR SEAL TO PREVENT WELL CONTAMINATION OR <br /> Proposed maximum pumping rate (gpm) samples only POSSIBLE HAZARDS AS AN OPEN WELL. THE WELL <br /> MUST BE KEPT LOCKED AT ALL TIMES EXCEPT DURING <br /> Average annual amount of ground water SAMPLING OR MEASURING. <br /> to be appropriated (acre-feet): 0 3) RECORDS OF WATER LEVEL MEASUREMENTS AND <br /> ' WATER QUALITY ANALYSES SHALL BE MAINTAINED BY <br /> Number of acres to be irrigated: 0 THE WELL OWNER AND SUBMITTED TO THE DIVISION OF <br /> WATER RESOURCES UPON REQUEST. <br /> Proposed total depth (feel): 60 4)_UPON CONCLUSION OF THE MONITORING PROGRAM <br /> THE APPLICANT SHALL PLUG AND ABANDON THIS WELL <br /> ' IN ACCORDANCE WITH THE RULES AND REGULATIONS <br /> Aquifer ground water is to be obtained from: FOR WATER WELL CONSTRUCTION AND PUMP INSTALLA- <br /> TION 5)OTHEOOWNERTSHALL MARK THE WELL IN A CONSPICU- <br /> OUS PLACE WITH APPROPRIATE WELL PERMIT NUMBER <br /> Owner's well designation #1 AND NAME OF THE AQUIFER. HE SHALL TAKE <br /> NECESSARY MEANS AND PRECAUTIONS TO PRESERVE, <br /> GROUND WATER TO BE USED FOR: THESE MARKINGS. 71 <br /> ' ti1zvl� , <br /> 1 I HOUSEHOLD USE ONLY - no irrigation (0) <br /> ( 1 DOMESTIC (1) 1 ) INDUSTRIAL (5) <br /> l 1 LIVESTOCK (2) ( 1 IRRIGATION (61 <br /> ( I COMMERCIAL 141 ( I MUNICIPAL (8) <br /> ' ( XI OTHER (g) Mnni tnri ng APPLICATION APPROVED <br /> DETAIL THE USE ON BACK IN It 1) �+a] <br /> J PERMIT NUMBER 31663 —Pl <br /> ' (4) DRILLER APR 22 1987 <br /> DATE ISSUED <br /> ' ame GROUND WATER SYSTEMS , INC. EXPIRATION DATE APR 2 31988 1 <br /> Street 4599 N. Broadway . ry <br /> ' City Boulder CO 80501 1 TE tvEERI (J <br /> (Slaw t2o1 1 <br /> .. pq �_C rod 091 BY <br />