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• i <br /> wRl•25-70 STATE OF C01£`?'fA00 1 <br /> Index No. _- -� _ , 01'�'l�i!ON Of S"115?£R i^ Ull frF�a <br /> OFFICE Of 1lfr STATE E!ZGeP�xP { <br /> en posluam <br /> Yield-_ _ MAP AND STATEMENT FCf CIATER>1`>E11 FILING <br /> DFr,r,locked By t <br /> PERMIT NUMBER _ - - - !. RFCE''9/7) <br /> WELL LQCATIO1f-, WATER Rfi ,.y <br /> STATE OF COLORADO I SS ,, STATE Er r <br /> $, CLAIMANT Isl 7 --- � /; �• <br /> of <br /> being duty sworn upon oath deposes and says that hs, (they) is farr.) t <br /> the owner(s) of the well described hereon; the total numlx r of acres <br /> i of land Irrigated from this well is 310. INDICATE WELL LOCATION ON DiARA4' <br /> work was cm. mencerl on this well by act:Ial construction on the <br /> /, NORTH <br /> " b clay of_.�.,.,t�I 19-&; the sustained , <br /> X I I <br /> ��- m, for which claim is hereby made I I I <br /> yield from said well is 9P <br /> .: for _purpose i s!; <br /> m FZ <br /> D <br /> the average annual amount to be diverted is uU, --- , - --T_--- r <br /> acre-feet; this map and statement is filed in compliance with 1, I I <br /> he(th-y) has (have) read the statements made hereon; knows the I ! <br /> --- - -- L---L--- <br /> cu�ttent thereof; and that the same are true of his (their) own <br /> knowledge. I I t <br /> , I I I <br /> y 1��� <br /> /\ Signature(s),(�j�--- SOUTH <br /> Address: <br /> t.?�,, `� �•� •�/.' — `�j/ e � �• / ( ��� WELL SHALL BE LOCATED WITH REFERENCE 7Cl <br /> �� �Z 3P <br /> ��• a t►t � ° � ' -- -�'--'-'- GOVERNMENT SURVEY CORNERS OR MONU""L"lTS, <br /> 0, OR SECTION LINES BY DISTANCE AND KKR! <br /> Subscribed and sworn to before me on this!._ ',—day <br /> 4 - , ft. from section I' <br /> of_G r 19� (North or South) <br /> My �:ommissiori expires: "— ft. from_ section li <br /> (Seal; r�;L i!t� - (Ewit or West) <br /> Notary Publo ` <br /> ;{ Ground Seater Basin d , -- <br /> WiTer Management <br /> WELL DATA <br /> _ r <br /> Date Completed <br /> Domestic +veils may be located by the fN i ' <br /> d �• '/ LOT BLOCK---- <br /> Static Water Level <br /> r SUBDINcISION qJ.1 .t, e.^�+/; t�✓ t�� i_ '�' -.._ <br /> Total Depth of t4rell J V L' <br /> ;'t.• FILING # <br /> i- <br /> ACCEPTED FOR FILING IN THE OFFICE OF THE STATE ENGINEER OF COLORADO ON THIS <br /> DAY <br /> p,.. OF 19 STATE ENGINEER <br /> FORM TO GE MADE OUT IN OUADRt.If L1LATE-. Vn4ITE FLw"i naafi be en original copy oat t}eSh pairs^s 8!T!f sigr+ed. <br /> �•• tditil?E AND CREEK copies rein,rst be tiled aaith the`:!U.••t c1? s'"M rritfrlto 30 t•+ys fatSN ts^e well is ce ,aet�a a Iieithin?�taay <br /> n..,.. . 11 vrl IOW CG?Y is for I"t?sillfir. <br />