2011-11-03_REVISION - M1986015 ‎(3)‎

• Permit No: M1986015
• IBM Index Class Name: REVISION
• Doc Date: 11/3/2011
• Doc Name: Comment- via email.
• From: Steve and Laurie Stratman
• To: DRMS
• Type & Sequence: AM4
• Email Name: TAK
• Media Type: D
• Archive: No

Form "
No.
GWS - I 1
K EnirE(
rt
STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
818 Centennial Bldg., 1313 Sherman Si, Denver, CO 80203
3) 866 -3581 Fax [phone]
mil!
For Office Use Only
RECEIVED
JAN 0 6 2004
WATER RESOURCES
STATE ENGINEER
��..// COLO.
re(/# 0 (93 k t, �
/ J
. NGE IN OWNERSHIP /ADDRESS
'DEC 2 2 / - RECTION OF THE WELL LOCATION
I` ,,, r , ,,
PUEBLO, COLORADO
Insert the
• 1D / —
Well Permit Number n5 T / y P
Name. address and phone of the person claimino ownership of the well;
NAME(S)
Mailing Address
City. St.
Phone ( 71 I
S7 STRBT�?�4 5Q
2 g-5 2 8' 7 . ' LANE
��
X SEC .trTR(Y/N�`
FeR OnveRIi.v.veRS
If your well has an absolute water right, decreed
by the court and the well is not registered with the
tate Engineer, enter the Water Court Case
Number / Civil Action Number and well number
as decreed.
/�
Zip D (ie CO
.
/ ` / -�r
q 1 ' 4 ' - 2 ! b /
This form is filed by the named individual/entity claiming that they are the owner of the well permitted as referenced above.
This Vino is made pursuant to C.R.S. 37 -90 -143.
WELL LOCATION: County Owner's
Well Designation
4 y- 0 E.
2/357 .
_PUEBLO
- 3 33 2- 8 r# 1.44/4- PPest,n
co gio01
(State) (Zip)
or10 W., 6771 P.M.
L_..I E. or 10W. Line.
, Filing /Unit
(Address) •
A/ W1/4 of the} 1/4, Sec. 35, Twp.
(City)
_2_Q11 N. or EIS., Range
Distance from Section Lines /D? , Ft.
JAt2f) Ft. From
From X N. or ■ S., _
Subdivision Name :___ _ Lot _ _____, Block
_ � ___
The above listed owner(s) say(s) that he she (they) own the well described herein., The existing record is being
amended for the following reasons: g Change in name of owner RI Change in mailing address
❑ Correction of location for exempt wells permitted prior to May 8, 1972 and non - exempt wells permitted before
May 17, 1965. Please see the reverse side for further information regarding correction of the well location.
I (we) claim and say that I (we) (are) the owner(s) of the well described above and that the commencement of
extraction of ground water from this well, lawfully made under the well permit, occurred on the date indicated, and
that the statements made herein are true to my (our) knowledge.
Please print the Signer's Name & Title
STE-ve Sr 4TMA�t /
Signature s) of the new owner.
Date
3
/2-21:203
_
12% IVv6/Z
.0
It is the responsibility of the new owner of this well to complete and sign the form. Signatures of agents are acceptable if an
original letter of agency signed by the owner is attached to the form upon its receipt.
For Of'Scc Use Only
• ACC22t'g at I *1I IN OWNERSHIP
AI■D /Ga MiAitis 13 ► !'1 ►
r
l ese At . 0 ' 4 bff 247'0
State Engineer By Date