2013-04-19_ENFORCEMENT - M1989056

• Permit No: M1989056
• IBM Index Class Name: ENFORCEMENT
• Doc Date: 4/19/2013
• Doc Name: CORRESPONDENCE REGARDING WATER SUPPLY
• From: KEHNS FORT COLLINS
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

Form
No.
OWS-11
11/2011
COLORADO DMSION OF WATER RESOURCES
DEPARTMENT OF NATURAL. RESOURCES
1313 Sherman St, Ste 821, Denver, CO 80203
Main: [phone] Fax [phone] dwroemtitsonlinefthstate.co.us
For Office Use Only
RECEIVED
C z 20i?
fife s
e ell of Itir I Ell
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CHANGE IN OWNER NAME/ADDRESS
CORRECTION OF THE WELL LOCATION
Review notruetiom on the revere side prior to corpksbs tie form.
oeS
Name. address and chow of Dotson claiming crammehb 01 the w mf�
Name(s): Don &ehn Construction. Inc.
Melling Addiess:6550
City, S.21p:
South Countv Road 5
Ft. Collins, CO 80528
Phone 970 - 226 - 4111 Emnu gddreax [e-mail]
This form is riled by the named lndMduafterfety calming that they are the owner of the well permit as referenced below. This Sky is made
pursuant to C.R.S. 37-90 -143.
Well Permit Number. 049719F Receipt No.: 009w Case Number:
County Larimer Weft Name or 0(optiarei)
X1/4 of the_,$y[
Distance tan
(Address)
1/4, Sec. 11 , Wm. 060 (S,' N. or G
(Cie)
S., Range 680 ®E or ®W.
N. or M S. 4200
(State) (h p)
S P.M.
Section lines: 700 Ft. From 0
Ft. From © E. or ®W. Una
as follows:
Unit must be set to true north.
, Filing/Unit —
OR GPS well location information in URA format. You must died( OPS unit for required settings
Famed must be UTM, 0 zone 12 or 0 zone 13 ; Units must be meteru Datum must be NAD83;
Easting Northing
Subdivision Name Lot Slod(._
The above listed owner(e) say(s) that he, she (they) own the well ps(mt described herein. The today record is being amended for the
following reasons:
ID Change in name of owner fa Change in matting address 0 Correction of location for exempt wells permitted prior to May 8, 1672 and
noneeeaempt wells permitted before May 17, 1985.
Please see the reverse side for further intmuton repardlnp correction of the well location.
1 (w )) ci a tha aim and d say that
true e) (an) ( ) Wf the own. s) of the well pemdl deecdbed above, knots the cantenb of the ai�mena made herein,
Sign or enter the name(s) of the new owner(s)
C21 —
if signing pint creme & title
Dan hehn, Vice - President
Date (mm/ddyyyy)
12/20/2012
It Is the responeibiuty of the new owner of this well permit to compete and /or sign this form. If an agent Is signing or entering Information
please seeInebuctons.
Please said caMm(ation of acceptance of charge in owner name/address
via Ng Emeti address
Anted above Qt J US Mali
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Sate 6hgfrheer By Date