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r! III IIIIIIIII1111111 ~ <br />STATE OF COLORADO "' ~ ° ~ u ~ II ~~11 III <br />sss ~ .-- <br />~ oao. u~ aw <br />OFFICE OF THE STATE ENGINEER <br />' pis carr.r ma. era ee.+.~ ~, t).w.r. Cob.ao emoa <br />r.+wt sers~tis+ <br />FOR INSTRUCTIONS, SEE REVERSE SIDE <br />STATEMENT OF BENEFICIAL USE <br />WELL PERMIT NUMBER 1(s2os4 <br />t. WELL OWNER <br /> NAME(S) J 6 L Farms <br /> Mailing Address 30500 Co, Rd. BB <br /> Cfry, SL Zip Akron, Cn 80720 <br /> Phone 3( 03 ) 345-6452 <br />2 WELL LOCATION: COUNTY Wachinornn OWNER'S WELL DESIGNATION <br /> (~~1 (c.vl Ism.l IDOI <br /> NW 1/4 ae,. SE 114, Sec. 27 Twp. 1 I] N. or ~ S., Range 52 ^ E. «©W. 6 P.M <br /> Distances from Section Lines 1440 Ft. from ~ N. v I] S. Line, 2007 Ft. from ~ E. « ~ W. Line. <br />3. The well is being used for the following purp0.Se(s): Domestic-Waterine of livestock on <br /> ranee and pasture--water 1 acre of Lawn d garden <br /> <br />4. Water from the well was first used beneficially for the above purpose(s) on ;/21/oZ 19 <br />5. The pumping raze claimed is 15 gallons per minute. <br />6. The average annual amourn of water diverted is 1 acre feet <br />7. The land area irrigated (watered) by water from this well is: one ®Acres or ^ Square feet, <br />HUne. <br /> ( <br />p <br />described as: Washington Co., NWT of the SEk, Sec. 27, 1N, 52W, 6pm <br /> (uqN t>.u4em1 <br /> o' as SubdNision Lot(s) Block FilingNnh <br />8. Well drilled by: ranfiPtd nrillinv CO Lic. No: 765 <br /> Pump installed by: y~mr, Pumn .c wP11 Funoty Lic. No: 1085 <br />9. Meter Mfg. by Serial No.: Dace Installed: <br /> I (we) have read the 5tazemerns matle herein, know the cornerns thereol, and state that they are true to my (our) <br /> knowledge. (Pursuant to Section 2a-a-104 (13)(a) C.R.S., the making of false statemerns herein constitutes perju <br /> in the second degree and is punishable as a Class 1 misdemeanor. <br />t 0 Name/1-rtle (rr~. ~. a omq ignazur ~ ~~/ <br />q'~ <br />--• Date <br /> J d L Farms, <br />Lynn Shook ~0 <br />.;ff.~~ _~~ 3/23/92 <br />FOR OF E USE ONLY <br />rror SltooK Grave ~ <br />Pi f. ~duell p~rml'ts <br />blur Eignwr t>Y l]W <br />Court Case No. Div. Co. WD Basin MD Use <br />