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«~ Z <br />WRJ-5-72• <br />Application must <br />be complete ~+here <br />applicable. Type or <br />print in BLACK <br />INK. No overstrikes <br />or erasures unless <br />initialed. <br />COLORADO DIVISION OF WATER RESOURCES 4/1773 <br />101 Columbine Bldg., 1845 Sherman St., Denver, Colorado 80203 <br />PERMIT APPLICATION FORM <br />~ 1 A PERMIT TO USE GROUND WATER <br />IX 1 A PERMIT TO CONSTRUCT A WELL <br />FOR: 1 X) A PERMIT TO INSTALL A PUMP <br />( )REPLACEMENT FOR N0. <br />( )OTHER <br />d <br />sr-t~~: <<~ ~gjd <br />~., -trE .: v. <br />o eti "JC,°O <br />Cp C,,, °. <br />~6~8 ` r0 rF. '. <br />FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br />NAME Mt's. J. R. Pate <br />STREET <br />P.O. Box 1470 <br />CITY Guymon, Oklahoma 73942 <br />t5tatal (ZiDI <br />TELEPHONE NO. LOS-~'iR-'1563 <br />(2) LOCATION OF PROPOSED WELL <br />County Las Animas <br />NE '/. of the ~ G, Section 30 <br />Twp.~_ ~, Rng. ~i$_ ~" h4.h P.M <br />•131 WATER USE AND WELL DATA <br />Proposed maximum pumping rate (gpm) 1 5 etttn <br />Average annual amount of ground water <br />to be appropriated (acre-feet): T.ecs than 1 ar•rP-font <br />Number of aces to be irrigated: Nnnr: <br />Proposed total depth (feed: 60 ft. <br />Aquifer ground water is to be obtained from: <br />Stonewall alluvial <br />Owner's well designation PA'1'~' <br />~r GROUND WATER TO BE USED FOR: <br />0 ~ 1 HOUSEHOLD USE ONLY - no irrigation (0) <br />( 1 DOMESTIC (1) ( 1 INDUSTRIAL (5) <br />( 1 LIVESTOCK (2) ( 1 IRRIGATION (61 <br />f 1 COMMERCIAL (41 ( )MUNICIPAL (61 <br />( l OTHER (91 <br />(4) DRILLER <br />~ame M.t~~ ~~ri ,11ing Co- No. 641 <br />Street Alamo Star Rrnrt.Pr Rnr g9 <br />Gtv `nralsenbur¢ Colorado 810E9 <br />lsurel lz~D) <br />Telephone No. Unkno~•rn Lic. No. 641 <br />Receipt No. ~~ ~~~ /_ <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 another owner of a vested water <br />right from seeking relief in a civil court action. <br />Approved for household use Dory. for one (~) single fem9y dMIIMQ end p1t to <br />lA used lar Irrlption. The realm flour tram flu ua M yip wep trt~ y <br />errnrd to the same sCeem system M rrhkh tM wfl B bt7tild. <br />~Y <br />APPLICATION APPROVED <br />PERMIT NUMBER 69193 <br />DATE ISSUED ~~ •1 ~~~~73• <br />EXPIRATION DATE ~ 1 111'1 <br />• E <br />r TA GINE <br />BY <br />i.D. _ 7- - ~_r1 r-n~ i~ITY .3 ~ <br />~' <br />