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,!Pit ter RA�s'"ry4 if tMY Vtnyer, cvkazlo V.210 <br /> POMW M &tA,-,l t4w, <br /> -STATEMENT Of BINEFILA U-4t Of GROUND WWR <br /> A!Ar-NOMENT Of I[XiSTING RECORD <br /> 0,7 <br /> PERMIT NUMBER <br /> STATE. Or COLORADO <br /> COUNTY OF 5_11 .7)] ft 5 <br /> THE AFFIANT(S)---/..--C-2---h'J./ <br /> -if- /o/Ire, 41 <br /> whose address i s saw.. <br /> be.ng duly sworn upon oath, deposes aid says that t",e (1111F,y) I'l—I th- of tt,,p oi-l! bed hereon t'- <br /> located in the 5 /y of Sect,on <br /> c-the % <br /> Range-- ; <br /> W I <br /> I !mot <br /> and-�/ ,j the sectto-1 line. the total ,it- t t cf ,,F, ell <br /> to-pt. *J1er. <br /> i[all C, V102.1 <br /> efici-31 use for thn purpose(s) dps�r,trd l-,- t�lt C I,,, k,11L <br /> was first a,:plied to trn- I/ is <br /> the rn-ivirrurn sus..Ained purlip,rig rate of the well is tr t,erety <br /> 4(� for wt,ich oa�rr <br /> gallons per minute. Vie average annuil amount of water to 1)(, div-1ed 5 /4 tCre (let, <br /> tf � " <br /> made for -II C v 2 e 'r,J J n 5 t 7, the legal vi., ILind on ivr, h, t u <br /> from this well s to te used it.- 4_ it S- , "� P t 4,V d. <br /> which total,, acres and which is illustrated on the w-ir, cr, averse !Ide (,,f tn,, forryi. tl�,,!l this NC-11 %%-I` CC-- <br /> ,n compliance with the prrmft appr3ved ttlerefor, this stntf-r.e--,t ;f b(,riefillal G e Of -round w rater i-; fired in ccr-.;,,' <br /> � <br /> lay#. tit (!hey) lias (hive) read the statement% made hereon knows tl�,e content ttjt,reot. -j that the same trp t 1!5' <br /> Weir) kr-,�,,,Acdze. <br /> 7 <br /> ran W31 0"1,y <br /> 1".rf Alnie.., ..n to before meon th-s day of <br /> ,7 <br /> Pl,nf Date <br /> Well 11%0 <br /> !0 <br /> T <br /> "'IF: F THE STATE Ff':G171ri <br /> DAY f <br /> 4t; <br /> r"i t'W'Icto <br />