2011-11-28_REVISION - M1986015

• Permit No: M1986015
• IBM Index Class Name: REVISION
• Doc Date: 11/28/2011
• Doc Name: Adequacy Review
• From: DRMS
• To: Continental Materials Corporation and Tuttle & Associates
• Type & Sequence: AM4
• Email Name: TC1
• Email Name: TAK
• Media Type: D
• Archive: No

e Form " •
No.
GWS-11
tEiv(r)
STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
818 Centennial Bkdg., 1313 Sherman St., Denver, CO 80203
866 -3581 Fax [phone]
For Office Use Only
RECEIVED
JAN 0'. 2004
WATER RESOURCES
STATE DOWER
.
�` ti �3 5.,- 5 .
- . NGE IN OWNERSHIP /ADDRESS
DEC 2 2 i'l': - RECTION OF THE WELL LOCATION
PUEBLO, COLOR
Insert the
�/
1 D # O D 4/
Well Permit Number 1)511 / y P
Name. address and phone of the person claiming ownershio of the well;
NAME(S)
Mailing Address
City. St.
Phone (
C7'01/4 STAATM�4A/
(-5-0% w= B
l/E
r
2 g-7 27/
If your well has an absolute water right, decreed
by the court and the well is not registered with the
State Engineer, enter the Water Court Case
Number / Civil Action Number and well number
as decreed.
• r
ZIp L • •
it SEE ATIkOlevr
7/71 9'y 8' - 2 I Z7 F Olfieh 41►.4110,5
This form is filed by the named individuallentity claiming that they are the owner of the well permitted as referenced above.
This filing is made pursuant to C.R.S. 37 -90 -143.
WELL LOCATION: County PLEBL 0 Owner's
Well Designation
2/ 357
333 8 rH 1, 4vtiE 1
CO 87DO1
(Address) • . (City)
/V W1/4 of the A 1/4, Sec. 35, Twp. 2 0 ❑ N. or g S., Range CV ❑ E.
(State) (Zip)
orlia W., 6rN P.M.
❑ E. or OW. Line.
, Filing /Unit
Distance from Section Lines Ft.
/goo Ft. From
From g N. or l S.,
.1___2_
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: S Change In name of owner El Change in mailing address
❑ Correction of location for exempt wells permitted prior to May 8, 1972 and non - exempt wells pemnitted 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
I've 5TJ T,,4 JI
Signature s) of the new owner.
Date
/2
aWA/6R
____Se9%
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 Iettei of agency signed by the owner is attached to the form upon its receipt.
For Mc Use only
ACCS7fgb a . _ a tN OWNERSHIP
A,■il /G7t M41i;
� 1 r
,44.1 21 e •
. a r " , / //I . 247.0`!
State Engineer By Date
041 os16g0