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WRS-5-71. COLORADO DIVISION OF WATER RESOURCES ?'-- <br />101 Columbine Bldg., 1845 Sherman Street, Denver, Colorado 8020 <br />TYPE OR PRINT IN BLACK INK. <br />APPLICATION FOR- <br />A PERMIT TO USE GROUND <br />A PERMIT TO CONSTRUCT A <br />REPLACEMENT FOR NO. <br />A PERMIT TO INSTALL A P <br />OTHER <br />APPLICANT <br />BE COMPLETED BEFORE CE:pTl . ,. <br />AUG L??v ? vb?d?D <br />2 <br />wR?, 197 <br />E <br />, lfq ?a <br />NGOU, <br />RCES C'j <br />C010 NEFR ?? <br />s? 66$ <br />Street Address Z/6 <br />City & State <br />Telephone.No. <br />NAMf+s OF AQUIFER GROUND WATER IS TO BE OBTAINED <br />FROM: I-A <br />PROPOSED TOTAL DEPTH OF WELL 80 Ft. <br />ESTIMATED MAXIMUM PUMPING RATE ' 15 GPM <br />AVERAGE ANNUAL AMOUNT OF GROUND WATER TO BE <br />.APPROPRIATED Acre-feet <br />ANTIC?P.ATED GROUT PROGRAM <br />Material Black Clay <br />Intervals Of 101 <br />Placement Method Hand <br />PROPOSED CASING: <br />Plain ?/8 in, from 0 ft. to 60 ft. <br />in. from ft. to ft. <br />Perf . 5 /A- in. from 60 ft- to 75- ft- <br />in, from ft. to ft. <br />Driller ?Ia Plata- Ma C. ;ne No• `193 <br />GROUND WATER TO BE US?`? <br />_X DOMESTIC l 1 E%n COMMER (I+) <br />LIVESTOCK (2) INDUST 'AL (5) <br />MUNICIPAL (8) IRRIGATION (6) <br />OTHER <br />WELL LOCATION <br />COUNTY A it <br />of the of Sections <br />T.', R. W , P.M. <br />IN ADDITION TO THE ABOVE, THE WELL, MUST BE <br />LOCATED WITH REFERENCE TO GOVERNMENT SURVEY' <br />CORNERS, MONUMENTS OR SECTION LINES BY DISTANCE <br />AND BEARING (DOMESTIC WELLS MAY BE LOCATED BY <br />LOT, BLOCK, & SUBDIVISION.) <br />%._ ft. from section line <br />North or.,South <br />-,,'$OQ ft. from ..._ section line <br />East 6r-West)- <br />LOT BLOCK FILING # <br />SUBDIVISION <br />Ground Water Basin <br />Wate.r.Mgmnt. Dist. <br />Anticipated dr.i.lling date June 1 19 72 <br />Owner of land on which well <br />is located: <br />Earl L. Thomason <br />Other water rights on this land <br />ignature of A licant <br />Address 6AR 213d.Avg. r=gW& . Qlorado <br />IF WELL IS USED FOR IRRIGATION, BACK SIDE OF THIS APPLICATION MUST BE COMPLETED. ?a 3 a <br />FOR OFFICE USE ONLY <br />CONDITIONS OF APPROVAL APPLICATION APPROVED: VALID FOR $,} YEARS <br />This well shall be and in such a way as to not cause AFTER DATE ISSUED UNLESS EXTENDED FOR GOOD <br />material injury to existing water rights. The issuance CAUSE SHOWN TO THE ISSUING AGENCY. <br />of this permit does not assure the applicant that no PERMIT No. 64335 <br />injury will occur to another vested water right or <br />preculde another owner of a vested water right from DATE ISSUED SEP ?. 2 1972 <br />seeking relief in a civil court action. <br />STATE NEER <br />BY