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sMtt tare 'Y;`°`±w?''.'A 4 "• "= i;r'"":?3 � <br /> COLORADO DIVISION OF WAUR RISOURCH L.•777 <br /> wq <br /> pept•t�lw A� )00 (.slrmktl++ Eid� i J4 Sher*•�re St, cl"':' 1+r'1, l - -"� <br /> ��, <br /> top. of 0, ;'NO Dtnref, Celow" 807•)3 <br /> titAtQMrt/t MAILE0 t+•, `._r(� ^�'l' :''.',. ��� <br /> at+ rt�oucst STATE OF COLOf*Ab0 <br /> C004TY OF _.__ _w.,. ._.� YV;,3. , i ce...�. I <br /> , <br /> ,�.._ STATEMENT OF ®EHEFICIAL 113E OF CROIIHO WATER <br /> AMMOM11"It OF E!(IST14C ffECOfID • ' c .; <br /> LATE REGISTRATION - 11 <br /> PERMIT MIJM13ER Q;12 7-fF LCICATI",►i Or VIFLL <br /> _ ! <br /> THE AFFIANT(S) _ Jahta 61g1� __ __._..V __ c+ _--•----- <br /> whese mailing <br /> address is A <*- ,17..- <br /> C , _ c�uAtoT3, T HE __Z?�.L_ ____._� T.e <br /> y n...rt trot ,• ti, i <br /> be .q dvly sworn upon oath, deposes o"d says t'"at he (they) is (are) the owneds) of the wail deacribed hereo•+, the wm!I1 i•, <br /> located as described above, at dtstonces of - — -�. feet from the section line ar.d _ __ leer ham 4 <br /> section line; water from this well was first applied to a beneficial ute for the pu►posoisl descnbe'i ftere,n on the 31 <br /> 6 <br /> day of ��*.�._..__�. . 19__5 , the maximum susoine•! pumping rate of the are11 is 2'-5-'�._gailans per minute, tf,e pve*o ^g <br /> fret, the average annual amov-1 <br /> rote claxmed booby "s - _ gallons per rcitnute; the total depth of the well as _ — 4 } <br /> F <br /> Of wets+ tabs dive,ted is 160 ccre•feet; for wh:cA claim is he•eby mode for Irritation. dcn-ttt <br /> _n t yi1R_]94"n purpose(s), the legoi dea_rtotion of the land on which the r►7ter from this welt -s used 's <br /> of wht'_*r <br /> .:etas ore irrigf tad and which is illustrated an the map en the reverse side of this form; that this well was completed <br /> cemplionce with the pernit approved therefor; ehis statea►ent of btneficin) use of ground wx- er is tiled in eomplienee with law, h1 <br /> (they) has (have) road the stotemente made herear,; knows the content thertof; and that t'ta some are true of his (ttleir) knowle-' •. <br /> (COMPLETE REVERSE SIDE OF THIS FORM) � <br /> Signoturof$) rota Orri"t ust OILY <br /> ---- <br /> Subscribed and sworn <br /> to belore me on this ---_ day of t9__., ; <br /> My Commission e><yares: ,_ _.__. ��__ _ -- Y, <br /> •r•. Pao _. Ike omt .__._.__ r-- <br /> ACCFPTED FOR FILING RY THE STATE ENGINEER OF COLORADO <br /> PURSUANT TO THE FOLLOWING CONDITIONS' � <br /> "a <br /> - -••• � c� —_ _____,,.mob_ ____ ___ __r,..ra.awsYa4iwNW+ir.,vJ -- w.. ,w «uant+s• wa.uiiWa di .i <br />