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Mar 04 10 02:10p Summit Engineering <br />17195896633 p.4 <br />APPENDIX B <br />Aug Plan 95CW24 <br />Certificate #C2mU06-2 <br />Permit # <br />Amount dedicated (Withdrawal or CU) 5 Aare-feet <br />AUGMENTATION PLAN INFORMATION SHEET <br />Participant Name_ Randall Robins <br />Property Address 8412 State Hi hwav 1 & County Id D 5 Cottejos River Trails <br />Mailing Address _ P O Box 212. Antonito. U 81124 <br />Telephone Number 719-376-2351 <br />Legal description of property to which water will be attached (all lands must be located <br />within the District's boundaries) Lot 2 also know as the Nw114 g the NE'/4 of Section 3. <br />Township 3 2 North Range 7 East of the New Mexico PrinciW Meridian. <br />Location of existing X. proposed well. NW 1/4 of the NE114 of Section , <br />Township 32 Nor S, Range 7E of, N.M.P.M. <br />Distance from N section line ---00 feet, <br />Distance from E section line 1- 400 feet. <br />() Application for New Well (Purchaser agrees to furnish to Conejos Water <br />Conservancy District a copy of the well permit and well log upon completion of the <br />well). <br />() Application for Existing Well. Permit No. <br />Depth (in. feet) <br />(Copy of existing well permit and well log must be attached and new permit <br />furnished to the District upon approval.) <br />Type of Use <br />(xx) ComMERCIAL For use at a grave it for dust control, washing of aravUlt <br />reclamtion and cement batch plant. <br />(X) RESIDENTIAL AND DOMESTIC (amount of lawn <br />garden included)_ 1000sguare feet <br />(} OTHER USES (net currently allowed under 93CW040 decree) NONE