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• <br />Form 'C Rev. STATE OF COLORADO <br />?-211 OR; A PERMIT TO USE GROUND WATER <br />APPLICATION <br />A PERMIT TO CONSTRUCT A WELL <br />Applicant L CATION OF WE <br />County <br />PIO. Address <br />Quantity applie or gpm or fjE of _J of Sect., Twp. <br />AF Storage <br />- - w Rge. ?? ? P.m. OR <br />Used f" Pur os6s ' <br />or p a I J l- - 1. on/at 0 <br /> <br />(legal description of land site) 4 3 <br /> !.r O <br />Total acreage irrigate an other rts. m o <br />ESTIMATED DATA OF WELL <br />Hole size: in. to ft. -Yo <br />U. to ft. <br />• Casing Plain-Z-in. froxu_?to S `? <br />in. from„?to?'??.? <br />? <br />Open or Perf. in, from to Jll ? <br />'0 <br />In. from to ft. 'A <br />PUMP utiet 7 44 <br />DATA: Type HP Size $M <br />Use initiation date 19? 0 <br />(Use Supplemental pag s r additional a) <br /> Aip <br />PERMIT NO. 1805`3 <br />ISSUED: <br />DATE 110V 18 19Q 19 <br />X <br />i •' 1 VWU Ut <br />4 <br />' N - <br />E <br /> , <br /> <br /> <br /> <br /> <br /> <br />Locate <br />well in <br />40 acre <br />E (small) <br />square <br />as. near <br />as possible. <br />Large square <br />is one section. <br />$25.00 fee required for uses other <br />than . Domestic or Livestock. <br />y' <br />Applicant <br />Agent or <br />Driller ??M g& 4 ,., No. <br />Address <br />NOTE - SATISFACTORY COMPLETION REQUIRED FOR APPROVAL OF APPLICATION <br />0