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9 ~ DIVISION OF WAT~ESOURCES, DEPARTMENT OF.
<br />ctiy: ~g • 101 Colum Bldg., 1845 Sharman Street, Denver,
<br />O
<br />A PERMIT
<br />TO USE GROUND
<br />WATER >: F •:
<br />h,:..
<br />~
<br />A PERMIT
<br />TO CONSTRUCT
<br />A WELL v -:~ r
<br />~• ~{7
<br />APPLICATION FOR: Q REPLACEMENT FOR N0, n "'~ :~
<br />~~ v Vdr
<br />L-X/ A PERhl1T TO INSTALL A PUMP ~F, o"'<sr,,,ti.;
<br />°
<br />~'
<br />~ OTHER ~'°,
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<br />9
<br />~
<br />PRINT OR TYPE LOCATION `=L;:;Z>~
<br />'
<br />OF WEL
<br />'APPLICANT ^ ' .~ f~~•~ ~~ ~ r 1i I~ ~
<br />- 1~ 1 COUNTY /.i I
<br />~ C~ f~ / ~~ `~ ~, ~~/ ~'l
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<br />.
<br />Street Address
<br />
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<br />~i /l .~ ,,,
<br />'-
<br />_
<br />
<br />i~l~ ~
<br />of the3 ///~•~,.!,
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<br />J/. ~
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<br />w, sec: ~ ~~ ~ •"
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<br />City b State T1 -~ i~:: l'.~ ~ ~ ~
<br />Use of ground water ~`-cL_J
<br />Owner of land on which,,}'~e]~1
<br />Owner of irrigated
<br />1 a n d ---i~ ~.-....~__ __ _
<br />Number of acres
<br />to be irrigated ~;~._:._
<br />Legal description of
<br />irrigated land ~,^,:c
<br />Other water rights on
<br />this land ~ti-ex-.--
<br />Aquifer (s) ground water is to be obtained
<br />from ~~ -~1, ~(~al
<br />Storage capaci t~ /(~-r~.~ AF
<br />T.~1 ~ R. .~~ ~ ~ ~ h ~~ P.M.
<br />Street or
<br />Lot b Block
<br />City or
<br />Subdiv.
<br />Ground Water Basin
<br />Water Management
<br />District
<br />Filing
<br />LOCATE WELL ON THE BACK pF THIS SHEET
<br />D r i l l e r ~a. ,,,~,r., ~~~(,,,,L N o. d`~ ?s
<br />Driller's ,~/~ ~ ,,
<br />Address C~c`,~ 7,>,~ C1~7~~ ~~;~c,r-c ~~c•.
<br />i ., ,
<br />1 /~
<br />.'
<br />Signature of Acolica~t
<br />[ONDITIONS OF~3P~___
<br />ANTICIPATED PUMPING RATE ~ ~ _S GPM
<br />AVERAGE ANNUAL AMOUNT OF GROUND 41ATER TO
<br />BE APPROPRIATED h-~~ Acre-fee[
<br />ESTIMATED 1JELL DATA
<br />Anticipated start of drilling ~~u~ 3 19Zp
<br />AntirlpaC=d start of lac .`ivt. %!~ '%~
<br />H[o~le Diameter:
<br />]{ ~ in, from ft. to ft.
<br />'T~ in. from ft. to ft.
<br />Casin :
<br />Plain in. from ft. to ft.
<br />in. from ft. to ft.
<br />Perf. in. from ft. to ft.
<br />in. from ft. to ft.
<br />ESTIMATED PUMP DATA
<br />Outlet ~.
<br />Type r t ~.QLHP ~ 5 i ze ~u
<br />APPLICATION h1U57 8E C01•IPLETED SATISFACTOP,ILY
<br />~r skooK G~ve-
<br />Pi f. ~We/J permrfs
<br />APPLICATION APPROVED:
<br />VALID FOR ONE (1) YEAR AFTER DATE ISSUED
<br />UNLESS EXTENDED FOR GOOD CAUSE SHOWN TO
<br />THE ISSUINu AGENCY
<br />PEP.MIT No, 4 3 8 5 2 CONDITIONAL O
<br />DATE ISSUED ~~C 1
<br />~_
<br />STATE ENG Ii EE
<br />BY
<br />
<br />1970
<br />F
<br />
<br />
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