Laserfiche WebLink
ax I ti rl. wwnwv of ~ fJfV v yr w.~l qrc nt~vun~na i/ <br />701 Columbine Bldg., 18A.i Sherman Street. Denver, Colorado 80203' <br />„'==E ?RINT IN BLACK INK. AP?LICATIO`: b?"ST BE COMFLETID BE_}ORS ACCEPTANCE, <br />" \i ~ <br />~LICATION FOR: <br />_ _ A PERMIT TO USE GROUND WATER <br />Y A PERMIT TO COivBTPUCT A W=~r,T, <br />}- F.EPLAC~T FCR .+G. <br />A PERMIT TO IPISiALL A FG?•r <br />OT'1TEt <br />:"PPLICANT <br />Street Address,>i,,,Jn curt/J ~lA.Z 14 <br />city & state lie s/T .v, ~e l ~l 01/ <br />Telephone No . ~/o ~ - o~~ ~ S <br />'.:ANIE OF A~~Q-~UI~,FER GROUND WATER I)1S TO BE OBTAINED <br />:~cOM: ~~orY~ (wla1~ CLltt!/LAl <br />PROPOSID TGTAL DEPTfi OF WELL ~_ Ft. <br />~TIMATID MA}CLb1UM P[JMPING RATE 1,> GPM <br />A'IFIiAGE ANNUAL, AMOUR"T OF GROUND WATER TO BE <br />t?=ROFRIATID l ~/~_ Acre-feet <br />A'" -CIPATID GROUT PROGRAM <br />Maial <br />In envois <br />h <br />GROUND WATER TG BE USED FOR: wsure <br />_~_ DOhU;STIC (1 CC?•II•a.'"F..tCf~' (4; <br />LIV?'STGCK (2) I~IPUSTRIAL (5, <br />i4UI'IICIFAL (`~) T Ir~IGATION (o; <br />CTHER /~o~e~o~aP~O n ~,~ - o-rw..~l><rw <br />ca'"~a.ctia rP. <br />WELL LOCATION /n~ 3~D <br />COUfiTY fT .S /7 A! //N A 5 <br />_~ 4 of the ~/~ u of Section 30 <br />IN ADDITION TO THE ABOVE, THE WELL MUST bE <br />LOCATID WITH REFERINCE TO GOVINNt~~-NT SURVEY <br />CORNERS, MONUMENTS OR SECTION LINES BY DISTANC= <br />AND BEARING (DOMESTIC WELLS t+IAY BE LOCATID BY <br />LOT, BLOCK, & SUBDIVISION.) <br />~~ft, from //O rTit section 1`_::- <br />North or South <br />a 9y S-ft, from ,q S'r"' sect;c:l 1`_:.= <br />~~ <br />J (East or West; <br />LOT .3 4 y BLOCK FILL?dG r <br />8,e/~ 5/G <br />SUBDIVISION STo~ver~,y/l ~l/9zA Gr-5F ~; <br />Ground Water Basin <br />Water Mgnnt. Dist. <br />Anticipated dr'.lling date ~'~/u 1? Z <br />Placement Method <br />PROPOSID CASING: <br />Plain ? in. from ~ ft. to 41 0 ft. <br />in. from ft, to ft. <br />Ferf. ~ in. from ~ ft. to ~ ft. <br />in, from ft. to ft. <br />Driller L/GFg/sfn No. <br />Owner of land on which well or Sonr/P /' <br />is located: / ~'~ <br />.-..J ~9 m e 5 ~/. /~., /~I~ r c~ <br />Other water rights on this land /j~ ye <br />Signature of Appl cant <br />gacress <br />IF WELL IS USID FOR IRRIGATION. BACK SIDE OF THIS APPLICATION MUST BE COMPLETID" d1 Q f!> <br />This well shall be used in such a way as to not cause <br />material injury to existing water righEs. The issuance <br />of this permit does not assure tha app:icant that no <br />injury will occur to another vested water right or <br />-"^culde another owner cf a vested water right from <br />.king relief in a civil court action. <br />for household use any, far one (1) single family dwelling and not to <br />lar Irrigation. The return flow Tram the use of this wen must 6e <br />retY to the same SVeam system In which the well is Wr2ted. <br />~~~ <br />APPLICATION APPROVID: VALID FOR ~ (~) YEAR <br />AFTER DATE ISSUID UNLESS EXTENDID FOR GOOP <br />CAUSE SHOWN TO THE ISSUING AGINCY. <br />PERMIT N0. fj'~4;~;~ <br />DATE ISSUED <br />BY <br /> <br />