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<br />~~~ <br />rofiUr4 <br />°"M° <br />-~ STATE - . ...... ...... _,._ <br />- - ..OFF1Ct:'bT~~TEBIt:~INEER-' .. ~.;:::i'ji';.~..-•_ - .. 'dYV _. ._._ .~ <br />~~~~.;.. <br />~ <br />ya eta cvter.r ~,... _.,_. <br />was..auarr..rar.o~wco~er.a~e:~•. i:: - <br />AECEIV <br /> <br />FruoR T o OOIa~1.ERNG Ft~FiU1, t~ ~srRUCT1ows Ot4 soy IUL 1 <br />2 <br />1999 <br />,• ~.~ . <br />: <br />~ <br />1 <br />.CHANGE-~N,n'YYN~~,f{(/~~F~IPJADQ ~;LOGA77C)N•~ <br />~J -~ ~ <br />' <br />•: <br />•~ <br />1 <br />W <br />,. <br />.t <br />.. <br />.s <br />~ <br />WELLPEiIMfT. WhS1DCKTAT~Yt: OR EROSIONOONTROLONA ~ <br />ER 9Flf7UHCF! <br />sr~ CoIO~HEER <br />1. NEW OWNER ~~/ '.I ~ .. <br />NAME(5) _~.~..1~dLl.~~ ~1/._~..__!c4Y..f.:_~/YG __..__ . <br />~y <br />~° <br /> 9 <br />. <br />~ ~a <br />~~ <br />~ as <br /> - : <br />-:~os3 <br />~~- <br />.~ g <br />wN <br /> ~.~9~~) ::~~ ~_ ,,mss--~ o <br />2 IH(8 CWINGE i5 FOR ONE~OF T <br />WINO: <br />HE FOLLO <br /> / <br />g <br />WELL PEAMR NUMBER_.CP_•J •S/......:.1~ .............._ ....~T 45~~~~ <br /> ^ <br /> LNESTOCK WATER TANK NUMBER ................................._.............. <br /> <br />^ _ <br /> EROSION CONTROL DAM NUMBER ............................................... ~SF ~ - SN_ ~i E A~ <br />3. WELL LOCATION: OOUNIY ................... ...... OWNER'S WELL DESIGNATION .. <br /> tAaa~rl tceyl (sacs! (zro) <br /> 1 <br />T <br />^ N <br />S <br />~ <br />^ <br />^ <br /> . « <br />...... <br />/4 atfts ...............1/4. <br />ec.........:..... <br />wp................ ~ <br />E «. <br />S., Rarge...__..__.: <br />W. ................P.M. <br /> . .. FL from ^ N. «LJ S. Line . ....................... Ft. from ^ E «^ W. Line. <br />Qistrtncee hom Section Lines........ <br /> Subdlvlsion .................... ..................................:~................ ~tqt..................... Bldck....................... Flfutg (Unlg.................... <br />~. LNESTOCK TANK OR EROSION CONTROL DAM LOCATION: COUNTY..._ ................................................................ <br /> ............... t/4. See.................. Twp.............. ^ N. «^ S.. Range................ ^ E «^ W. ................. P.M. <br />5. The above listed ovmer(s) say(s) that he (they) own the taructure desaiped herecL <br /> roa5ting record ie being emended for the following reason(s): <br />T <br />h <br />e <br /> l~ <br />~p <br />( <br />Y~I Chaage in name of owner. ^ Change in mailing address. ^ Carregion of location. <br />6. I (we) have rwd the steaemarns made herein, know the coraents dtereof, and ate that they are t1Ue <br /> t0 ny (011f) 1QIOWledgB. <br /> (Pursuers to Section 24-4-104 (t3)(a) C.R.S., the making of tales aatemems herein catwhanm peQury In <br /> the second degree and w punishable d a lass 1 msdemettrtor,J <br /> Nttme/Thk (Please type or pr4a) Signature Dale <br /> <br /> ,O O Y PG/f <br />FOR OFFlCE US ONLY <br />AfA.CNANG'E. Ft OUt~ll~! <br />M7AQ, ADORlSS. <br /> <br />see. Wl,n« r a! n.o. <br />Court Case No._ Div.~_ Co.,~~ WO_~ Besln_ __ MD _ Use <br />Z0 39tld <br />NOS '8 NCWddfltlN 3NtlC <br />SB66L990L6 ZL~TT 666T/ET/80 <br />