Laserfiche WebLink
WRA.25-72 COLORADO DIVISION OF WATER RESOURCES <br />THIS FORM MUST-BE <br />sunmiftEri Pkift TO.".'- 141 Columbine $Idg., r 1845: Sherman St. , <br />THE EXPIRATION OF THE Denver, Colorado`80203 <br />PERMIT. TYPE Oft <br />PRINT IN BLACK INK. <br />A4 STATEMENT OF BENEFICIAL USE OF GROUND WATER <br />AMENDMENT OF EXISTING RECORD <br />PERMIT NUMBER0W-< <br />STATE OF COLORA <br />t SS. <br />COUNTY OF <br />THE AFFIANT <br />L, <br /> <br />?V01-W <br />0 <br />WpZE? ?Se__,,Rp? <br />whose address is <br />being duly sworn upon oath, deposes and says that he (they) is (are) the owner(s) of the well described hereon; the well is <br />located In the of the IV F/ 1/A of Section A , Township JL Al (N. or S.) <br />Range W , P.M. at distances of ? feet from the iLl section line <br />(E, or W.) (North or South) <br />and ??oo feet from the W section line; the total depth of the well is feet; wafter from this well <br />(East or West) <br />was first applied to a beneficial use for the purpose(s) described herein on the of ?'?4y 19; <br />the maximum sustained pumping rate of the well ismgallons per minute, the pumping rate claimed hereby is /457 <br />gallons per minute; the average annual amount of water to be diverted is acre-feet; for which claim is hereby <br />made for ____L_.___?___.___ purposes}; the legal description of the land on which the water <br />from this well is to be used is ?JjA 5I'LJ S6-C• ;k!uN%l-1iP Y36 A)$_?e4,,N66,--(/ Yb A/, 41,'•At, _ <br />which totals acres and which is illustrated on the map on the reverse side of this form; that this well was completed <br />in compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with <br />law; he; (they)- has.`(h.ave) read the statements made hereon; knows the content thereof; and that the same are true of his <br />(their) kh6wiedge, =:y <br />esoo?o_ <br />Sign a"tu re(sl.. <br />Subscribed and •sworc? b before me on this ?-? day of FOR OFFICE USE ONLY <br />19 Prior. Date 19 <br />My Commission expi <br />(Seal) <br /> <br />Notary Public <br />ACCEPTED FOR FILING IN THE OFFICE OF THE STATE ENGINEER OF <br />COLORADO ON THIS DAY OF _ , 19 . <br />Well Use_? <br />3/a, 1/a, 1/a. Sec. , <br />T. R. P.M. <br />Co. <br />STATE ENGINEER <br />Index <br />WHITE COPY FOR DIVISION OF WATER RESOURCES I <br />PINK COPY FOR WELL OWNER