Laserfiche WebLink
PIRJ•5•Rev. 76 <br />Application must <br />be complete where <br />applicable. Type or <br />print in BLACK <br />INK. No overstrikes <br />or erasures unless <br />initialed. <br />COLORADO DIVISION OF WATER RESOURCES RECEIVED <br />816 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br />pFC'EIVED PERMIT APPLICATION FORM <br />1, ( ) A PERMIT TO USE GROUNDWATER <br />PAP 1619 FOR: j X} A PERMIT TO INSTAL A PUMpELL <br />k. L,% 6EjQUKM ( ) REPLACEMENT FOR NO <br />:,TATS 4111101190 <br />COLO. I ) OTHER <br />WATER COURT CASE NO <br />FEB 14 '91 <br />?i. VJAr: ;? rt f,0URCE5 <br />V •,??it" ItitER <br /> <br /> <br />x (1) APPLICANT - mailing address <br />NAMEC-19a .? ` L n%"_'? <br />STREET P.O. • D-)? )0q <br />CITY- VAA <br />(State) (ZIM <br />y <br />TELEPHONE NO. 3o l S-3 <br />(2) LOCATION OF PROPOSED WELL <br />County Gilpin <br />of the- _'/•, Section 22 <br />Twp, Rng. ) P,M <br />IN,S) 1EA <br />(3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate (gpm) 01, <br />Average annual amount of ground water !?3 <br />f to be appropriated {acre-feet) : - <br />Number of acres to be irrigated: <br />Proposed total depth {feet): 20e <br />Aquifer ground water is to be obtained from: <br />Owner's wel l designation <br />GROUND WATER TO BE USED FOR: <br />( X) HOUSEHOLD USE ONLY - no irrigation (0) <br />{ ! DOMESTIC (1) ( ) INDUSTRIAL (5) <br />( 1 LIVESTOCK (2) ( ) IRRIGATION (6) <br />( ) COMMERCIAL (4) ( ) MUNICIPAL (B) <br />( ) OTHER 19) <br />DETAIL THE USE ON BACK IN (11) <br />(4) DRILLER <br />Name C.R. Smith Drilling <br />Street 104 Gap Road <br />City <br />Itale} ( p <br />Telephone Nose ye'Z'_ 333 4 Lic. No. 3-29 <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMI?)_ <br />Receipt Nol, ?Q.2 <br />Basin Dist. <br />QONDITIONS OF APPROVAL <br />This well shall be used in such a way as to cause <br />no material injury to existing water rights, The <br />issuance of the permit does not assure the applicant <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 court action. <br />,41'r?fb. iN?0. <br />r? <br />APPLICATION APPROVED <br />PERMIT NUMBER <br />DATE ISSUED <br />EXPIRATION DATE <br />(STATE ENGINEER) <br />BY <br />I.D <br />_ COUNTY C? <br />_.-sue