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M'RJ-S~Rev 76 COLORADO DIVISION OF WATER RESOURCES <br />818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br />i~ <br />1 <br />II <br />Application must <br />be complete where <br />applicable. Type or <br />print in BLACK <br />INK. No overstri kes <br />or erasures unless <br />initialed. <br />PERMIT APPLICATION FORM <br />( ) A PERMIT TO USE GROUND WATER <br />1 A PERMIT TO CONSTRUCT A WELL <br />FOR: 1 ~ A PERMIT TO INSTALL A PUMP <br />( 1 REPLACEMENT FOR N0. <br />1 1 OTHER <br />WATER COURT CASE N0. <br />' 111 APPLICANT -mailing address <br />NAME Connell Resources, Inc. <br />STREET 4305 East Harmony Road <br />CITY Fort Collins, CO 30525 <br />(State) (2.p) <br />' TELEPHONE N0. (,970,LZ23-3151 <br />(2) LOCATION OF PROPOSED WELL <br />' County Lorimer <br />'/. of the Sly Y., Section 3 <br />' Twp. 6 ~. Rng, fib W 6th P M <br />iN.51 iE.WI <br />' (3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate Igpml 1,(100 <br />' Average annual amount of ground water ~ <br />to be appropriated (acre-feed: 3.8~ acre-feet <br />' Number of acres to be irrigated: D <br />Proposed total depth (feed: 15 <br />' Aquiter ground water is to be obtained from: <br />Cache La Poudre River alluvitun <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />Receipt No. / _ <br />Basin Dist. <br />CONDITIONS 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 />Owner's well designation Wellington Downs Pit Well <br />GROUND WATER TO BE USED FOR: H~ <br />' ( }HOUSEHOLD USE ONLY ~ no irrigation 101 <br />1 }DOMESTIC 111 1X1 INDUSTRIAL IS) <br />1 LIVESTOCK 121 ( 1 IRRIGATION 161 <br />( 1 COMMERCIAL 141 ( 1 MUNICIPAL 181 <br />' 1 1 OTHER 191 APPLICATION APPROVED <br />DETAIL THE USE ON BACK IN {111 <br />1 <br />PERMIT NUMBER _ <br />141 DRILLER <br />DATE ISSUED <br />Name N~A EXPIRATION DATE <br />Street <br />City <br />Telephone No <br />(STATE ENGINEER) <br />BY <br />Lic. No. <br />I.D <br />COIINTV <br />