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NfiJ-5-75 <br />r <br />Applicriion must <br />be complete where <br />applicable. Type or <br />print in BLACK <br />INK . No overstr i kes <br />Oi eerasures unless <br />initialed. <br />ORADO DIVISION OF WATER RE> ' •~CES <br />300 „nbine Bldp., 1845 Sherman St., Danver, ,do 80203 <br />PERMIT APPLICATION FORM <br />(X 1 A PERMIT TO USE GROUND WATER <br />(X 1 A PERMIT TO CONSTRUCT A WELL <br />FOR: (X) A PERMIT TO INSTALL A PUMP <br />REPLACEMENT FOR NO <br />1 OTH E R <br />WATER COURT CASE N0. <br />(1) APPLICANT • mailing address <br />NAME Suaerior Sand and Gravel Co. <br />STREET 123 Santa Fe Drive <br />CITY Denver, Colorado 80223 <br />iso<,<t tz~cl <br />TELEPHONE NO. 825-2211 <br />(2) LOCATION OF PROPOSED WELL <br />C.>,in[y Arapahoe <br />SW % of the PIE '., Section 11 <br />Twp. ~_ ~, Rng. _~{i,-_ ~1L, 6th P.M <br />I N,SI E W <br />(3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate Igpml 1000 <br />Average annual amount of ground water <br />to be appropriated (acre-feed: 3.1 <br />Number of acres to be irrigated: Nnr,a <br />Proposed total depth flee[(: 20 <br />Aquiler ground water is [o be obtained Irom: <br />Suhtarranean sand <br />Owner's well designation Agora Plt <br />GROUND WATER TO BE USED FOR: <br />1 1 HOUSEHOLD USE ONLY no irrigation i01 <br />1 1 DOMES( IC 111 1 I INDUSTRIAL 151 <br />1 1 LIVESTOCK 121 1 1 IRRIGATION (61 <br />1 X 1 COMMERCIAL 141 ( 1 MUNICIPAL iel <br />1 I OTHER 191 <br />DETAIL THE USE ON BACK IN (111 <br />(41 DRILLER <br />Name Self <br />Street <br />City <br />I t<t<1 ILO) <br />Telephone No <br />Lic. No. <br />(STATE ENGINEER( <br />BY <br />I.D <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />Receipt No. <br />Basin <br /> <br />Dlst <br />NDITIONS OF APPROVAL <br />This well shall be used in such a way as to cause <br />no material injury to existing water rights. The <br />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 />right from seeking relief in a civil court action. <br />APPLICATION APPROVED <br />PERMIT NUMBER <br />DATE ISSUED <br />EXPIRATION DATE <br />COUNTY <br />