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_ _ fl2r']9/2990 98:47 <br />ERNIES MOUNTAIN DRII_ PAGE M <br />3938383319 <br /> COLOIIADO 01VISION OF WATER RESOURCES <br /> 818 Celitelinfal Sldg.• 1313 Sherman St.• Denver, Colorado $020 <br /> PERMIT APPLICATION FORM <br /> <br />!y-1 ':i(alliiil ntVxl <br />!r: rnitp)rle wNrt,. <br />(X) A PERMIT TO USE GROUND WATER <br />an)tlitcnhlle. t ytu! AI (X) A PERMIT 10 CONSTRUCT A WELL <br />iniol in VILACK FOR: (x) APERMIT TO INSTALL APUMP <br />IN Y,. (?U Ov¢tStt ikas <br />.n ..r?ilNnr'. unh•as <br />FOR NO. --- -------• <br />{ )REPLACE MENr <br />Hole to Water Well <br />.rlrll.tll:l) r <br />(XI011HERUrn)it;,,,yto ?.0 yq.L JS" <br /> IYATER COURT CASE NO. <br />(1) APPLICANT • mailing addr(As <br />t;Ar?I:_COLVR,ADO..5C11PS& UF_MINES_ <br />M1111n Engineering Department <br />`:1 ItI:F: I .l$Utl_tl.l.ino.18:-..----?- _ (.1 1 Y.. - _GoZd@tt,. Colot?adq,_?OtZl <br />I •tdrr) (7r0J <br />(2) t_UG;?TION OF PROPOSED WELL <br />(r.l„rly.,,-_ Clear._Creek. __-- <br />SW SrxtFCin 35 <br />3. 5, Rrig. 73 P <br />tl. Cr , r.VY, <br />FOR OFFICE USE ONLY: 00 NOT WRITE IN Ilil& Uuwt.. <br />Receipt No. / - <br />Basin _ nist. .. <br />qmg [IONS OF APPROVAL <br />This well shall be used in such a way as to cause <br />no material injury to existing water rights. Thir <br />issua!lceof the permit does not assure the applicvltt <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 />13) WATER VSE,.AND WELL DATA <br />r-v,,%rrl ,r axitimm vitnivint? rate (itliin) -11 _U <br />M"'18tH i•rtllltii( •3111(itlflS of gluland water ,. <br />IM be auplohrinlcd Iacrr•(leU: _ -_----.. ___ 1/3 Acre-feet 18 exempt commercial well and wl.11 <br />be granted almost automatically'above that will <br />rr,,,„I,rt ..t parrs to ttt irliMalert:..._ _. _.-None require augmentation plan or similar approval. <br />Arpdfrl grnu(ul water is us )le ohlanier( trnm: <br />Fractures in granite <br />If yQu desire flue„c,•s ivrll (trcigntltion __ .?,,,,.__ he well, ca be named or left blan <br />01OUN.0 W&1'ERT9QE USEp FOR <br />I ! Hitl!SFlli)I I1 tf$F (?NI Y no inigatinn ((?) <br />r I n()AAFSn(:.(1) 1 1INUUSVIiAL (5) heck applicable box-If you go the exempt route <br />( t 1 IVr5IV(:K (7) ( ) IRRIGAIION (G1 of 1/3 acre-feet check. commercial and other and <br />( I CttMPAE(IGIAL (4) ( ) MUNICIPAL (8) larite EXEMPT behind -other <br />i I () I HE 11 (R) APPLICATION APPROVi~D <br />L?ETAIL THE USE ON BACK IN (11) <br />N M ER - - <br />14) OAILLE)3 <br />rJ;ime ,_,,,ERN1E.L5_MQU=AJN 121171. ANQ, INC. <br />Slrect _1156 NOy_A -ROAD _ <br />City PINE, COLORADO 80470 <br />.. _ . _...._ <br />Vinl <br />?(Slal?) <br />Ielenhnne Nn. _SYQ290 _ Lie. Nn. 1078 <br />St'11A..n!. ?r ( <br />PERMIT U e <br />DATE ISSUED <br />EXPIRATION DATE <br />(STATE E GINEER <br /> <br />BY <br />