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<br />CCLCitA00 OIVISICV OF'J;.Te.R ReriURC-=
<br />I;15T3UCT~CNS FCR CCY.?!='I`IGrE=:+IT :.?°LIC:.TIC•'1
<br />Please nc :e ;hat this fo rnn must Se completed where acolicable and :•.ced cr ? r.'n;ed in
<br />Slac:< ink (far Cuo!icaL:ng :u r;oses), ?+e3se indite :e a: t=e ;_ :he ~~: r;cse of ,he
<br />acol;cac!an by piaeine an (X) mar'< iR :he apprcoriate ;:ices. Ao7licaLio.-. fees are
<br />^e. refundable, The `ollcwine is a Srief ouLli,:e for co rp le;ing :=e fora. The I;err
<br />number corresponds co the number on ;he acolica;icn for,,
<br />I T=!7
<br />(I) 3P°!IC?NT - Cor.pltt_ in full. (CcoieS o' Ltie pernit and all cc rresoc r.d once will
<br />oe sent to ttiis addre35 unless ccher.+ise resues;ed).
<br />(2) !CCAT IC!1 CF ?RCPC ScO ': "c!! - Corpletz Baca Slank, Tye 1/4 of •he I/:+ sec:idn,
<br />section numoer, [cwr.ship (C+p) and range(rna) eac`t.~us: be desi_na;e?.
<br />(3) 'JATe.R US"c :.NO'JE!! DAT.l - Give: proposed puroing rats, acre-fee: (refer to
<br />'.lacer equivalent Taoie on the Sack of the 'era), ir-. igated acres if any, oc'e rwi5e
<br />"RCne" proposed total depth, acuifer if i,cwn (;his can Se sand, sand and :rive!,
<br />sandstone, granite e;=. or ;he geological nzme), anC owners ~+e!1 !esi:Ra;'on if
<br />2RV, 5LQ^ d5 name 6r .ncr.6er.
<br />G?OUNO y?iER TC 3E U c7 =GR: Cne or .x re of ;he uses must Se indicated. "r:CC cr.CLJ
<br />USe ONLY .roans solely for ;.cue ei+old pu r:eses •+i t.`t rc -u;side i '.3: ~~.: 7f ~'•wR
<br />er torten. Oa.rac .aar'< "CC~ESTIC" far ;his use. CCrESTIC should ze cnec'<zc =;r
<br />household and/or lauvn and garden irrigation of one acre cr Ies3. This can also
<br />inc!uee use for •+atericg of dames;ic animals. IR41CAT10Y should be c.`.ecked
<br />when irrigating .-are than ohs acre.
<br />(1+) CRI!L°_.~ - This should Se ccrple:ed iR full if a driller has been selected.
<br />o;her.+ise "licer.s ed" or "eel"'. elf •+el1s must be cons:r:;c;ed by a driller
<br />;icenSed in ;he S;ace of Co!orade or by yourself ai:h r^'uirmenc owned and
<br />ocerated by you.
<br />(JJ T1E !CGT!C`+ CF Tut :oR°nee7 'JE!! i`te ioCa[ion cf :he •+el l r,.us; Se incicated
<br />en ;he ciaarzm Sy an "::", If Cne •+ell is used f7r irritation cur;.oses ..:_ lard
<br />area ;o Se irrigated -u5; Se ;hated or crosshatched to ':he dia°ran,
<br />;~) 'Jc ! LCC.371CN - The die:arcz frcr+ :he section lines "L_ST a elves for all ~-ells,
<br />"eke sure this corrssgcnds •Ni;h Che I/4 of ;he 1/4 section Ioc3;icn in Ise- (,:;,
<br />(7) TRACT - T;,e number of acres S~.culd be given as acc•u rarely as cossiSle. "!ess than
<br />one" is Buff is ions on 5~-all trot ;s of less ;hen One zc re. ,11;0, indicate ~' .his
<br />is :o Se the only •+ell rn ;ha; giver, tract and ::ne c•+ner,
<br />(9) FRCP^, SE] CASING ?R:G R:N - This i3 imco rtes; info r_aticn :o :::ne JiviS'on of 'Dater
<br />Resources for evaluacien of ;he aoolicaticn. The total deoch should ccrresccnd
<br />' with proposed :zilch stated in Itt"+ (;). ?!ease indicate ar.y UnC35ed in:era:
<br />anticipated zrd size of :pals, Your well driller can belt you with ;hi; it=-,
<br />if necessary,
<br />(5) F;R RE?'.CE"e'f' 'JE!!S - Ccmolete es icdica;zd.
<br />(10) L4A0 :`+':ilC:q ;FCUNC'J~T'cR'Ji" 2E JSE7 -!and car,er's (s') na.:e (s) -u5; Se
<br />:neicacee 'or :he 7rCCC5eG '+e!i, T'e numeer Of c'Gres ar.d local destr•_. Cn -::4:
<br />Se given for all pr7cesed ~we114 sxcepL for he us a:^.old, 'cr..•stic :r 3::c~ ~+e:'S
<br />wneR located cn 3 •r3C. cr lent of less ;.`.an shit^/-five („-) acres,
<br />(i!) 7ETAI!e~7 3ESC71 r.!C.'I of :=e uSe of around water: "cr Comr•erc'al, Incus;rizi ant
<br />runic'cal wells :his should g~ve info ^a;ion such as :ur_er cr oeoole series,
<br />nur..cer of :acs, use cf :tie '+ater ar_a ser•+e?, _._. '=cuseratd ard =_^ss:'_ -e!~;
<br />-u4; nd !caLe :y,^e of disccsa! 2•!4 :_^. I' _t~er ,ion set:~_ .ae< arc ___.. ..el _,
<br />explain hc•w s-r _ent sill r_:.r, ;o Same s;ream SYS;em ..~-nits ~.,_il :5'Icca:_t.
<br />Use ex:r3 scac_ if •-._~3star!. .
<br />(i _) - ?i :a'c3 RI.:~T -If env, _ ease ..~?ice :_.
<br />(!;) .;IA TURe The aoolicit.`tn -c4: 'Se s _nee in .I~C'< .:'~< 7V 3t°i'd3n; tr h'a
<br />2U t~:Cf::e° scent.
<br />Contact a ..ell dr~l!er for a4;i5:3nCe ~" ._.e3;ar'+.
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