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Receipt No. 3647656 WELL PERMIT NUMBER 284387 Page 2 <br />ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT <br />CONDITIONS OF APPROVAL <br />NOTE: This permit will expire on the expiration date unless the well is constructed by that date. A Well Construction and <br />Test Report (GWS-31) must be submitted to the Division of Water Resources to verify the well has been constructed. An <br />extension of the expiration date may be available. Contact the DWR for additional information or refer to the extension <br />request form (GWS-64) available at http://www.water.state.co.us/pubs/forms.asp <br />NOTICE: This permit has been approved subject to the following changes: The distances from section lines were <br />calculated from UTM coordinate values provided with the permit application. You are hereby notified that you have the right <br />to appeal the issuance of this permit, by filing a written request with this office within sixty (60) days of the date of Issuance, <br />pursuant to the State Administrative Procedures Act. (See Section 244104 through 106, C.R.S.)