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<br />PERMIT N0. - ~~i9-~ <br />• NO STATEMENT OF BENEFICIAL USE FiAS BEEN RECEIVED. THIS FORM IS BEING <br />FILED IN LIEU OF THE STATEMENT OF BENEFICIAL USE. THIS DOES NOT <br />CONSTITUTE EVIDENCE OF BENEFICIAL USE, NOR DOES IT ESTABLISH A WATER <br />RIGHT. ANY FURTHER ACTION ON THIS PERMIT MUST BE PRECEEDED BY AN <br />ACCEPTABLE STATEMENT OF BENEFICIAL USE. <br />NAME <br />ADDRESS ~°• ~ ~ -6o X /~/~o - c ITY~sT~zIP ~~ ~ ~' <br />WELL LOC. R.(B~T.~~s,S. ~0,1/4.~~.1/4~..~_P.M. <br />DISTANCES -3~5 FT. FROM (NORTH, SOUTH) SECTION LINE <br />---- <br />~~FT. FROM (EAST, WEST) SECTION LINE <br />DATE WELL COMPLETED 6-!~- 73 <br />TOTAL DEPTH OF WELL .S-~ FT. <br />STATIC WATER LEVEL i7 FT. <br />PUMPING RATE is G.P.M. <br />ANNUAL APPROPRIATION i ACRE FT. <br />ACRES TO BE IRRIGATED o <br />USE CODE o <br />DIV.~,CO.~,DIST.~,BASIN -,MAN.DIST.- <br />• <br />