Laserfiche WebLink
-VrRl-5-74 _ <br />application must <br />complete where <br />ppliwble. Type or <br />print in BLACK <br />INK. No overstri kes <br />or erasures unless <br />initialed. <br />( )REPLACEMENT FOR N0. <br />( (OTHER <br /> <br />PERMIT APPLICATION FORM <br />dq,A PERMIT TO USE GROUND WATER <br />'bQA PERMIT TO CONSTRUCT A WELL <br />FOR:~•Q/i PERMIT TO INSTALL A PUMP <br />COLORADO DIVISION OF WATER RESOURCES <br />101 Columbine Bldg., 1845 Sherman St., Denver, Colorado 80203 <br />ri~,- <br />1 '^i J <br />Rf~IVE~ <br />~~$~7~- <br />WATER RfS~W:C": <br />~E ENGIxE=+~-+ <br />Cotn. <br />• mailing address <br />NAME ~~EGi2 FF_ . 9'' E[Fr/A.'ER. ~fR L L <br />STREET fa ~PCt./. ~vSF_P/F, ,Sgi,tl ~ <br />SroN<µ~F~LL HP <br />CITY „/~STe .~) CoL~ . y/a 9 / <br />(sate) tzlP) <br />TELEPHONE NO.~~-~ 3 3 ~~ <br />(2) LOCATION OF PROPOSED WELL <br />Cou~fnt~y/~~1 ~~~//~'l9s <br />._[y_~'/. of the~~~jj ~,,Y''.,//Section/ Q <br />Twp. . ~ '~ ~, Rng• 1P1L- CAL. <br />:)WATER USE AND WELL DATA <br />Proposed maximum pumping rate Igpm) ~~ <br />Average annual amount of groundwater / <br />to be appropriated (acre-feet): <br />Number of acres to be irrigated: ~O iY~ <br />Proposed total depth (feet): -_- ~ D <br />Aquifer groundwater is to be obtained from: <br />.~~ cry i d / <br />Owner's well designation <br />GROUND WATER TO BE USED FOR: <br />{>Q, HOUSEHOLD USE ONLY • no irrigation (0) <br />( )DOMESTIC 1.1) ( ) INDUSTRIAL.(5) <br />( )LIVESTOCK 12) ( )IRRIGATION (B) <br />( )COMMERCIAL (41 ( )MUNICIPAL (B) <br />( 1 OTHER 191 <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />Receipt No.~z 1~ ~6 / <br />Basin Dist. <br />CONDITIONS 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 anotherowner of a vested water <br />right from seeking relief in a civil court action. <br />APPROVED FOR HOUSF~fOLD USE ONE.Y; FOR ON€ <br />(1) SINGLE FAMILY DWELLING AND NOT TO BE <br />USED FOR IRRIGATION. THE RETURN FLOW FROM <br />THE USE OF TH[5 WELL MUST BE RETURNED TO <br />THE SAME STREAM SYSTEM tN WHICFI SIiE WELL <br />IS LOCATED. $R.b- <br />APPLICATION APPROVED <br />PERMIT NUMBER <br />14) DRILLER <br />DATE ISSUED _ <br />~~ <br />~~ame ~ EXPIRATI <br />trees~~~ /~D X ~ °3 ~i / <br />City /l~~iYl Cad ~, ~ /U• J ~D ~o2 / <br />(Sbtal Iz~PI L_7r~ '- <br />Y <br />Telephone No. O `~f~ - ~~~~ Lic. No. ~,z B 1'~~G~~-i, ~ ~ ~ , - 1~~+ <br />A/O ~,,,i .(n ti ^~i901 ~r TiY~.r Tr ^+~C I.D. ~ ~ Il COUNTY ~~ <br />