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Form <br />No. GWS -2 NON - EXEMPT <br />612009 STATE OF COLORADO <br />DIVISION OF WATER RESOURCES <br />OFFICE OF THE STATE ENGINEER <br />821 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br />(303) 866 -3581 Fax (303) 866 -3589 <br />WELL PERMIT INFORMATION, PERMITS APPROVED PURSUANT TO CRS 37- 90- 137(2) <br />Carefully read the conditions of approval on your well permit. The conditions and the information on <br />this information sheet must be complied with in order for the permit to remain valid. <br />THE ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT <br />The well permit number is located in the upper right corner of the permit, and the expiration date is <br />located in the lower right corner. <br />THE WELL PERMIT EXPIRATION DATE IS ONE YEAR FROM THE DATE ISSUED. Evidence of well <br />construction and pump installation must be received on appropriate forms PRIOR TO THE EXPIRATION <br />DATE OF THE PERMIT. The required forms are the Well Construction and Test Report (Form No. GWS -31), <br />and the Pump Installation and Test Report (Form No. GWS -32). There are penalties if evidence of well <br />construction and pump installation is not received prior to the expiration date. The licensed contractor or well <br />owner (under the private driller or pump installer statutes and rules) performing the work is responsible for <br />completing the appropriate form(s) and submitting it to the Division of Water Resources. <br />The expiration date of the permit may be extended one time only for a period not to exceed one year for <br />good cause shown, at the discretion of the State Engineer. If an extension of time is necessary to construct the <br />well and /or install pumping equipment, the owner must file a written request for the extension, along with a $60 <br />filing fee. The request and fee must be received by the State Engineer prior to the expiration date. The request <br />must state why the well has not been constructed and /or pumping equipment installed, and must include an <br />estimate of time required to construct the well and /or install pumping equipment. <br />Water well construction and pump installation contractors are licensed in Colorado to perform these <br />specialized tasks. It is illegal for individuals who do not hold these licenses to construct wells and <br />install pumping equipment in or on wells. The well must be constructed and pumping equipment <br />installed by contractors with current license(s) issued by the State of Colorado unless exempted as <br />described on the reverse side. Additional information regarding well construction, pump installation, required <br />testing and well plugging and sealing regulations are found on the reverse side of this sheet. <br />You have been provided with at least one copy of the well permit. Keep a copy for your records. At least <br />one copy has been sent to the well driller if you indicated a driller license number on the application. You may <br />make additional copies for the well driller if you select one different from the one indicated in your application. <br />The original permit is on file in our Denver office Records Section. Copies may be obtained for a fee of 50 cents <br />per page. Statutes require that any change of mailing address or ownership be reported to the State Engineer. <br />Use Form No. GWS -11. There is no filing fee. <br />If you have questions, contact the Denver Office, or the Division Office in the area where your well is located. <br />Division 1 . <br />Division 2 <br />Division 3 <br />Division 4 <br />810 9" St., Ste. 200 <br />310 E. Abriendo Ave Ste B <br />301 Murphy Drive <br />1871 East Main St. <br />Greeley, CO 80631 <br />Pueblo, CO 81004 <br />Alamosa, CO 81101 <br />Montrose, CO 81401 <br />(970) 352 -8712 <br />(719) 542 -3368 <br />(719) 589 -6683 <br />(970) 249 -6622 <br />Fax 970 392 -1816 <br />Fax 719 544 -0800 <br />Fax 719 589-6685 <br />Fax 970 249 -8728 <br />Division 5 <br />Division 6 <br />Division 7 <br />Denver Office <br />Direct mail to Box 396 <br />Direct mail to Box 773450 <br />160 Rock Point Dr. <br />1313 Sherman St. Rm. 818 <br />Glenwood Spgs CO 81602 <br />505 Anglers Dr. Suite 101 <br />Ste. E <br />Denver, CO 80203 <br />50633 U.S. Hwy 6 8 24 <br />Steamboat Spgs, CO 80477 <br />Durango, CO 81301 <br />(303) 866 -3581 <br />Glenwood Spgs., CO 81601 <br />(970) 879 -0272 <br />(970) 247 -1845 <br />Fax (303) 866 -3589 <br />(970) 945 -5665 <br />Fax (970) 879 -1070 <br />Fax 970 <br />( ) 259 -0944 <br />Fax 970 945 -8741 Call First <br />