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1 <br />Form No. OFFICE OF THE VTATE ENGINEER`S <br />GWS -25 COLORADO DIVISION OF WATER`RESIO`IJrRCES' <br />818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203 <br />(303) 866 -3581 <br />APPLICANT <br />WELL PERMIT NUMBER 273265 - <br />DIV. 6 WD 44 ,DES. BASIN MD <br />Lot: 4 Block: Filing: Subdkr S.CHWAN. MINOR <br />MOFFAT COUNTY <br />NW 114 NW 114 Section 18 <br />BRIANNA MONTGOMERY Township 6 N Range 91 W Sixth P.M. <br />PO BOX 160 DISTANCES FROM SECTION LINES <br />DIXON, WY 82323- 990 Ft. from North Section Line <br />1399 Ft. from West Section Line <br />(307) 321 -1836 LITM COORDINATES Meters Zone:13 NAD83 <br />'ERMIT TO CONSTRUCT A WELL tasting: Northing: <br />ISSUANCE OF THIS PERMIT DOES NOT CONFER A WATER RIGHT <br />CONDITIONS OF APPROVAL <br />1) This well shall be used in such a way as to cause no material injury to existing water rights. The issuance of this permit <br />does not ensure that no injury will occur to another vested water right or preclude another owner of a vested water right from <br />seeking relief in a civil court action. <br />2) The construction of this well shall be in compliance with the Water Well Construction Rules 2 CCR 402 -2, unless approval <br />of a variance has been granted by the State Board of Examiners of Water Well Construction and Pump Installation <br />Contractors in accordance with Rule 18. <br />3) Approved pursuant to CRS 37- 92- 602(3)(b)(1). <br />4) The use of ground water from this well is limited to fire protection, ordinary household purposes inside not more than 1 <br />single family dwelling, the irrigation of not more than 1 acre of home gardens and lawns, and the watering of domestic <br />animals. This well is to be located on Lot 4, Schwan Minor Subdivision, Moffat County. <br />5) The pumping rate of this well shall not exceed 15 GPM. <br />6) This well shall be constructed not more than 200 feet from the location specified on this permit.--­? ,7 <br />APPROVED <br />JSG <br />F E <br />State Engineer <br />3615081 DATE ISSUED <br />By <br />EXPIRATION DATE <br />r, <br />