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1313 Sherman Street, Room 818
<br />Denver, Colorado 80203
<br />DO NOT WRITE IN THIS BOX
<br />NAME OF DAM , WATER DIV , DAMID , C-
<br />DATE RECEIVED APP. COMPLETE? YES NO , DATE RETURNED
<br />APPLICATION FOR REVIEW OF PLANS AND SPECIFICATIONS FOR THE CONSTRUCTION OR
<br />ENLARGEMENT OF A DAM AND RESERVOIR
<br />(File in duplicate, original signatures required on both)
<br />(PLEASE PRINT OR TYPES APPLICATION)
<br />CHECK ONE: New Dam ? , Enlargement .
<br />(SEE C.R.S. 37-87-101, et al, and Regulations for Dam Safety and Dam Construction
<br />4
<br />owner, hereby accept and approve the
<br />(Name of Owner) r /
<br />enclosed pla s nd ecif' do s f sub Mal to the State Engineer in accordance with § 37-87-105, C.R.S.
<br />ZI 6
<br />(Signature of Owner/Agent) (Date)
<br />Address: Z 9 Si 5 Qo U Tr C_ot) NTy 12.okD *2-7 On k &ee. rO 9V4(0 7
<br />Street or P.O. Box City, State, Zip Code
<br />Phone Number ("o) F10 -2750
<br />Owner Code: (CHECK ONE): Federal(F), Local Government(L), Utility(U), Private(P),
<br />State(S),
<br />NAME OF DAME (ON FILE WITH THE STATE ENG): NI DAMID:
<br />Also known as:
<br />RESERVOIR NAME ryA7-'f (L S7t12A6E lzac RVO I R_
<br />STATE ENGINEER'S DRAWING FILE NUMBER (on file with the State Engineer, i.e., C-nnnnx): AI
<br />Yuv Z31 /I# At (o7 0 a) W
<br />Location: 1«P .M., Twnshp t5 A] , Range ?6 4, Section 2-0 , Lat. , Long. , County
<br />Stream Name: Cree-lC , Tributary to: Tra '/-t CTe4--k,
<br />GENERAL INFORMATION
<br />Dam and Reservoir Use: N1 A/r AIC-
<br />(Augmentation, Diversion, Domestic, Erosion Control, Evaporation, Flood Control, Fire Control, Fish, Hydroelectric, Industrial, Irrigation, Mining,
<br />Municipal, Pollution Control, Recreation, Stockwater, Settling Ponds, Tailings, Waste Disposal)
<br />Consulting Engineer: /rain Len Company: /V (A/ CC
<br />Address: Z S
<br />7
<br />or P.0.13ox) City i v State Zip Code
<br />Phone Number: 07? ?701 - 7???- Colorado P.E. Registration Number: 257S-0
<br />(PAGE 1 OF 3)
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