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WRJ--5-•71 ? COLORADO DIVISION OF WATER RESOURCES <br />101 Culumline Bldg., 1$45 Sherman Street, Denver, Colorado 00203 <br />TYPE'Y PRINT IN BLACK INK. APPL'I'CATION MUST BE COMPLETED BEFORE ACCEPTANCE. <br />),ICATI0I4 F'W- <br />A FMXT TO USE GROUND WATM <br />A P T TO CONSTRUCT .A. WELL <br />REPLACEMENT FOR NO. Jy'0'S-- . <br />A PERMIT TO INSTAJ L A PUMP <br />OTHER <br />APPLICANT <br />Street Address '6 <br /> <br />GROUND WATER TORE USED FOR: <br />DOMESTIC 1 CO=41 ) <br />LIVESTOCK (2) INDUS?'R (5) <br />'?"• MUNICIPAL ($) IRRTCTATION (6) <br />OTHER <br />WELL LOCATION <br />COUNTY C'1r*? <br />u of they) t,J 4 of Section T <br />City.& State Ale y.A=d d T. 3_ -11? , R. 2._ &) , P.M. <br />IN ADDITION TO T19, ABOVE, THE WELL MUST BE <br />Telephone No. 7`of o?- O 282,3 LOCATED WITH REFERENCE TO GOVERNMM SURVEY <br />NAME OF AQUIFER GROUND WATER IS TO BE OBTAINED CORNwS, MONUMENTS OR SECTION LINES BY DISTANCE <br />AND BEARING (DOMESTIC WELLS MAY :BE LOCATED BY <br />FROM: - R - c T r? ? - CF l/ 'T LOT, BLOCK, & SUBDIVISION.) <br />PROPOSED TOTAL DEPTH OF WELL Ft. ?'O ft. from section a..ine <br />North or South <br />ESTIMATED MAXIMUM PUMPING RATE; <br />Ae_ GPM ?_ fit. from section line <br />Fast or West <br />AVERAGE ANNUAL AMOUNT OF GROUND WATER TO BF <br />APPROPRIATE) ?' ' ere-feet <br />WCIPA KD GROUT' PROGRAM <br />Material CR,- M' J ^('-' <br />LOT ? BLOCK -- FILING <br />SUBDIVISION /V6i) -44- <br />Ground Water Basin <br />Water Meant. Dist. <br />Intervals <br />Placement Method U2rrT - c2CLr= 7-- <br />PROPOSED CASING: <br />Plain ?7U in, from ft. to p ft. <br />?r ire. from ft. ? <br />to d 0 ft. <br />. <br />Perf. ?. in. from 1oO ft. . <br />to ft. <br />in. from ft. _ <br />to ft. <br />Driller ` E '23 g 64 DTa. <br />Anticipated drilling date 19 -7z <br />Owner of land on which well <br />Is located: <br />Other water rights on this land <br />Sa.gnature of Applicant -••_._.___ <br />Address _QgQ u1 ?5??l?,?e,•??-w'?? ,P, <br />IF WELL IS USED FOR IRRIGATION, BACKS E OF THIS APPLICATION MUST BE COMPLETED. <br />FOR OFFICE USE ONLY <br />CONDITIONS OF APPROVAL APPLICATION APPROVED: VALID FOR ONE 1 YEAR <br />AFTER DATE ISSUED UNLESS L'XTENVEl1 FOR GOOD <br />CAUSE SHOWN TO THE ISSUING AGENCY. <br />MMIT 110. AP04IJ-A <br />DATE I S SUED - J U N 8 1872 <br />STATF ENGINE <br />BY Or