PERMFILE132666

• Permit No: M1992038
• IBM Index Class Name: Permit File
• Doc Date: 7/24/1992
• From: JUDITH L HAMILTON
• To: ADCO CONSULTING
• Media Type: D
• Archive: No

WRJ•S~R.v. 76
Application must
be complete where
applicable. Type or
print in BLACK
IN K. No overstrikes
or eerasures unless
initialed.
(1) APP
c
NAA9E s
STREET
CITY
mailing
COLO~O DIVISION OF WATER RESOURCE
818 Centenma Bldp., 1313 Sherman St., Denver, Colorado 80 3
PERMIT APPLICATION FORM
`~'A PERMIT TO USE GROUND WATER
(71 A PERMIT TO CONSTRUCT A WELL
FOR: ( A PERMIT TO INSTALL A PUMP
REPLACEMENT FOR N0.
(OTHER
WATER COURT CASE N0.
FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN
Receipt No.
Basin
Cl
Dist.
CONDITIONS OF APPROVAL
TELEPHONE N0. ~~- ~~- $~~$
(2) LOCATION OF PROPOSED WELL
County f/ n` ~1
,~~~/ _'/. of the'/., Section
Twp. ~ ~, Rng.~~
IN.51 IE.WI
(31 WATER USE AND WELL DATA
Proposed maximum pumping rate (gpm) _~
Average annual amount of ground water L'
to be appropriated (acre•feet): , / O
Number of acres to be irrigated: `~~ ~ ~ L-
Proposed total depth Ifeetl: /
Aquifer ground water is to be obtained from:
~~X ~/LL
Owner's well designation
GROUND WATER TO BE USED FOR:
( )HOUSEHOLD USE ONLY
( )DOMESTIC 111
( 1 LIVESTOCK 121
(.COMMERCIAL (41
y OTHER 191
no irrigation 10)
( ) INDUSTRIAL I51
( )IRRIGATION (61
( )MUNICIPAL (81
DETAIL THE USE ON BACK IN (11)
(4) DRILLER
Namc ~~ ~~ L /~~~ ~r/O~
Street/~Q a ~ ~~G ! /
City %~ CL=~TJ'A~~ C ~ ~O O/O}
I~~/ // (state( (Zrilole7
Telephone No./ 6 9 `7 J` ~ ~ Lic. No. ~y
This well shall be used in such a way as to cause
no material injury to existing water rights. The
issuance of the permit does not assure the applicant
that no injury will occur to another vested water
right or preclude another owner of a vested water
right from seeking relief in a civil court action.
APPLICATION APPROVED
PERMIT NU
DATE ISSUED
EXPIRATION DATE
(STATE ENGINEER(
BY
I.D. COUNTY