2011-09-26_PERMIT FILE - C1981012A ‎(4)‎

• Permit No: C1981012A
• IBM Index Class Name: Permit File
• Doc Date: 9/26/2011
• Section_Exhibit Name: EXHIBIT 11 WATER WELL INFO PART 3
• Media Type: D
• Archive: Yes

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Application must
be complete where
pplicable. Type or
int in BLACK
INK. Noovers[rikes
or erasures unless
initialed.
a:i
COLORADO DIVISION OF WATER RESOURCE~C^[`vEp RECENE
101 Columbine Bldg., 1845 Sherman St., Denver, Colorado 80 i -
PERMIT APPLICATION FORM Mpy 13'l6 t~IAV ~~~~~'
t~1 A PERMIT TO USE GROUND WATER ~AtER ~tGN~ WST7~TERENGIN t?
b4 A PERMIT TO CONSTRUCT A WELL o»-~ y-U,tE OptO-
FOR: ~-{ A PERMIT TO INSTALL A PUMP ~~', 1.
(>CI REPLACEMENT FOR NO.
( (OTHER
(1) APPLICANT -mailing addrtss
NAME v° ~•y /y, /.J e d!-d N .f~
STREET dd ~, o ~
CITY Ti .vi dd~.~ o/at-duo ~~og,~.
~tsueel tzio)
TELEPHONE NO. ~~~~- ~O l,LO -
(2) LOCATION OF PROPOSED WELL
Coun/~ty'',~ d S' ~iV, iy/ ~ S ~ ~
N • [.t~. Y. of the /gyp '/., Section ~L=,_
Twp.~ 5 . Rng.~ ~. ~~/ Th P.M.
(3) WATER USE AND WELL DATA
~oposed maximum pumping rate (gpm) 6
Average annual amount~of ground water
to be appropriated (acre-feet):
Number of acres to be irrigated: //O/Y '~
Proposed total depth (feet): ~
Aquifer ground water is to be obtained from:
ffLavi ~ ~
Owner's welt designation ~ dce ~c fo
'. ,N~ e.dl- a.v ~
GROUND WATER T BE USED FOR:
( HOUSEHOLD USE ONLY - no irrigation 101
( X) DOMESTIC (11 ( )INDUSTRIAL (51
( 1 LIVESTOCK (2) - ( )IRRIGATION (61
( 1 COMMERCIAL 14) ( )MUNICIPAL (8)
1 (OTHER
(4) DRILLER
FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN
Receipt No. ~ O O ~ Z~
Basin Dist.
CONDITIONS OF APPROVAL
This well shall be used in such a way as to cause
no material injury to existing water rights. The
issuance of the permit does not assure the applicant
that no injury wi11 occur to another vested water
right or preclude another owner of a vested water
right from seeking relief in a civil court action.
APPROVED AS A REPLACEMENT OF WELL N0a ~ 3 ~~ ~I ,
THE EXISTIN>; WELL ICIUST BE PLUGGED AND ABANDONED
ACCORDING TO THE REVISED AND AMENDED RULES AND
REGULATIONS FOR WATER WELLANL PUMP INSTALLATtON
CONTRACTORS. THE ENCLOSED AFFIDAVIT MUST BE
SUBMITTED WITHIN SDCfY (60) DAYS AFTER THE
CONSTRUCTION OF. T} E NEW WELL, AFFIRMING THAT,
WELL NO.~''I' WAS PLUGGED AND ABANDONED.
APPLICATION APPROVED
PERMIT NUMBER
DATE ISSUED
Vame ,/~~ t°~ EXPIRATI6~M
treet ~~ a ~J
City^/ h/ N% O~F~ c~, (n~4s~r~o ~[O ~.~i ~~y
)seas) tz~o) ~~'~`
Y
Telephone No. /~ ~"6 ~ °?~~~ Lic. No. ~ ~ br
_T LD.~~ ~~.~ COUNTY --~