Laserfiche WebLink
,0J.8-Rev, 76 COLORADO DIVISION OF WATER RESOURCES RECEIVED <br />1318 Centennial Bldg., 1313 Sherman St,, Denver, Colorado 80243 <br />PERMIT APPLICATION FORM JUL 17'91 <br />Application must WATER WSOURCES <br />be complete where (x) A PERMIT TO USE GROUND WATER STATE WMEER <br />applicable. Type or (?-() A PERMIT TO CONSTRUCT A WELL / COLO• <br />print in BLACK FOR: 1A) A PERMIT TO INSTALL A PUMP <br />INK, No overstrikes n <br />or erasures unless ( } REPLACEMENT FOR N0. <br />initialed. ( ) OTHER <br />WATER COURT CASE NO. <br />(1) APPLICANT - mailing address <br />NAME &nYI / ?9- 4. (5",q 7de- <br />STREET c .2.( UY6L016 S7" <br />CITY X04/ 021,A Gv.?0 qoo t' <br />(State) (ZIP) <br />TELEPHONE NO. y 3 --2 / 41 <br />(2) LOCATION OF PROPOSED WELL <br />County er i L A, n <br />5 F % of the N W Y4, Section 3 <br />Twp. -5-, Rng. '73 P.M. <br />I N,S) { E, W) <br />(3) WATER USE AND WELL DATA <br />Proposed maximum pumping rate (gpm) 16 <br />Average annual amount of ground water / <br />to be appropriated (acre-feet): 3 <br />Number of acres to be irrigated: ki G h -. <br />Proposed total depth (feet): 30 0 <br />Aquifer ground water is to be obtained from: <br />Owner's well designation O >7 -e.- <br />GROUND WATER TO BE USED FOR: <br />( HOUSEHOLD USE ONLY - no irrigation (0) <br />( 1 DOMESTIC (1) ( ) INDUSTRIAL (5) <br />( ) LIVESTOCK (2) ( } IRRIGATION (6) <br />( ) COMMERCIAL (4) ( 1 MUNICIPAL (8) <br />( ) OTHER (9) <br />DETAIL THE USE ON BACK IN (11) <br />(4) DRILLER <br />Name (?- R Smt-?k ZYk\? ktn <br />Street f y G a 10 12 t <br />City 13 4-wc,h L4A-wL C $d it 7- <br />(state) (Lip) <br />Telephone NoLe??2 Lic. No S O <br />A <br />APPLICATION APPROVED <br />PERMIT NUMBER <br />DATE ISSUED <br />EXPIRATION DATE <br />(STATE ENGINEER) <br />BY /J <br />COUNTY. <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />t <br />Receipt No. / <br />Basin Dist. N <br />CONDITIONS OF APPROVAL 6 <br />This well shall be used in such a way as to cause <br />no material injury to existing water rights. The <br />issuanceof 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 a civil court action.