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WRJ•5•Re.. 16 COLORADO DIVISION OF WATER RESOURCES <br /> 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado 80203 1'"'rt7 <br /> PERMIT APPLICATION FORM FEB 2 G 9Z <br /> Application must <br /> be complete where A PERMIT TO USE GROUND WATER <br /> applicable. Type or ( I A PERMIT TO CONSTRUCT A WELL VAT .�s� ES <br /> print in BLACK FOR: ( ) A PERMIT TO INSTALL A PUMP =TAT-A n'EER <br /> INK.No overstrikes C0L0. <br /> or erasures unless ( ) REPLACEMENT FOR NO. <br /> initialed. I I OTHER <br /> WATER COURT CASE NO. <br /> (1) APPLICANT • mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br /> NAME C .O.M. inc /J .W.TATMAN Receipt No. / <br /> STREET 9145 SUNSHINE CANYON Basin Dist } <br /> CITY TtOTTT PR 170- R0407 <br /> (State) (ZIP) CONDITIONS OF APPROVAL <br /> TELEPHONE NO. 303-449-7746 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 /> BOULDER right or preclude another owner of a vested water <br /> County right from seeking relief in a civil court action. <br /> NW G of the SE '/, Section 12 <br /> Twp. 1N _ Rng. 72 W W P.M. <br /> MS)SI I E.M <br /> (3) WATER USE AND WELL DATA <br /> Proposed maximum pumping rate (gpm) 50 <br /> Average annual amount of ground water 7. 5 <br /> to be appropriated (acre-feet): <br /> Number of acres to be irrigated: node <br /> Proposed total depth (feat): 250 ' <br /> Aquifer ground water is to be obtained from:FOUR MILE CREEK ( Seadt�98&Rap ) <br /> Owner's well designation MINE SHAFT <br /> GROUND WATER TO BE USED FOR: <br /> I 1 HOUSEHOLD USE ONLY no irrigation (01 <br /> 1 I DOMESTIC (1) ( '1 INDUSTRIAL (5) <br /> 1 1 LIVESTOCK (2) 1 ) IRRIGATION (6) <br /> ( ) COMMERCIAL (4) QT g T 1 1 MgUVNIICIPPALA((88) <br /> NO CONSUMfJ6RN1001TS0� TRIEGRYON NAPPLICATION APPROVED <br /> 1 1 OTHER (9) <br /> DETAIL THE USE ON BACK IN (11) <br /> PERMIT NUMBER <br /> (4) DRILLER <br /> CASH MINE PATENT # 68 DATE ISSUED <br /> Name PRE-EXISTING MINE SHAFT <br /> — EXPIRATION DATE <br /> Street <br /> City IStatq (z.ol (STATE ENGINEER)41 E•� L h , / <br /> Telephone No. Lic. No. BY <br /> I.D. COUNTY <br />