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12� <br /> wRJ-5-Rev. 76 COLORADO DIVISION OF WATER RESOURCES <br /> 818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br /> PERMIT APPLICATION FORM R�C��t��� <br /> Application must 61-1 <br /> a� �(�O <br /> e complete where (X) A PERMIT TO USE GROUND WATER 4 1 U <br /> applicable. Type or { ) A PERMIT TO CONSTRUCT A WELL <br /> print in BLACK FOR: ( ) A PERMIT TO INSTAL L A PUMP WATER RESOURCES <br /> INK.Nooverstrikes SATE MGINEER <br /> or erasures unless { ) REPLACEMENT FOR NO. WL0-- <br /> initialed. { ) OTHER <br /> WATER COURT CASE NO. <br /> (1) APPLICANT - mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN <br /> NAME MID-CONTINENT COAL AND COKE C2'1PAtirY Receipt No. / <br /> STREET P. 0. BOX 158 Basin Dist. <br /> CITY CA.RBONDALE, COLORADO 81623 <br /> (state) (zip) CONDITIONS OF APPROVAL <br /> TELEPHONE NO. (303) 963-2581 This well shall be used in such a way as to cause <br /> no material injury to existing water rights. The <br /> (2) LOCATION OF PROPOSED WELL issuance of the permit does not assure the applicant <br /> that no injury will occur to another vested water <br /> GARFIELD right or preclude another owner of a vested water <br /> County right from seeking relief in a civil court action. <br /> SIV Y. of the SE ;4, Section S <br /> Twp. 7 S. , Rng. 88 W. 6th P.M. <br /> MS)s) ;E,W) <br /> 1) WATER USE AND WELL DATA <br /> Proposed maximum pumping rate (gpm) 15 <br /> Average annual amount of ground water <br /> to be appropriated (acre-feet): 1. 5 <br /> Number of acres to be irrigated: 0. 5 <br /> Proposed total depth (feet): 85 <br /> Aquifer ground water is to be obtained from: <br /> River Uavels <br /> Owner's well designation No. 2 <br /> GROUND WATER TO BE USED FOR: <br /> ( ► HOUSEHOLD USE ONLY • no irrigation (0) <br /> { ! DOMESTIC (1) (X) INDUSTRIAL (5) <br /> ( ► LIVESTOCK (2) { } IRRIGATION (6) <br /> { ) COMMERCIAL (4) ( ) MUNICIPAL (8) <br /> { )OTHER (9) APPLICATION APPROVED <br /> DETAIL THE USE ON BACK IN 01) <br /> (4) DRILLER PERMIT NUMBER <br /> DATE ISSUED <br /> COLLINS DRILLING CO, <br /> :ame EXPIRATION DATE <br /> Street 0589 THO�fAS RD . <br /> City CARBONDALE, COLORADO 81623 (STATE ENGINEER) <br /> (slate) (zip) <br /> BY- <br /> Telephone No. f) _28_1 2 Lic. No. 4 c� 2 <br />