HomeMy WebLinkAbout1.0 Application111
BEFORE THE BOARD OF COUNTY COMMISSIONERS OF
GARFIELD COUNTY, COLORADO
PETITION FOR EXEMPTION
Pursusant to C.R.S. (1973) Section 30-28-101 (10) (a) - (d) as
amended, and the Subdivision Regulations of Garfield County, Colorado,
adopted April 23,"1984 Section 2:20.49, the undersigned Gerald W.
5�j.�QwaV`'_-
respectfully
petitions the Board
of County Commissioners of Garfield County, Colorado, to exempt by
Resolution the division of 80 acre tract of land into 2 (two)tracts of
approximatel Tract I 7.4.3 ac
Y mra�t-.I1 acres each, more or less, from the definitions of
'7'2`50 ac
"subdivision" and subdivided land" as the terms are used and defined in
C.R.S. (1973) Section 30-28-101 (10) (a) - (d) and the Garfield County
Subdivision Regulations for the reasons stated below:
7.436 acres as a gift to my nephew, Gary D. Galloway
SUBMITTAL REQUIREMENTS:
An application which satisfies the review criteria must be submitted with
all the following information.
A. Sketch map at a minimum scale of 1"=200' showing the legal
description of the property, dimension and area of all lots or
Leparate interests to be created, access to a public
right-of-way, and any proposed easements for drainage,
irrigation, access or utilities;
B. Vicinity map at a minimum scale of 1"-2000' showing the general
topographic and geographic relation of the proposed exemption to
the surrounding area within two (2) miles, for which a copy of
U.S.G.S. quadrangle map may be used.
C. Copy of the deed showing ownership by the applicant, or a letter
from the property owner(s) if other than the applicant; and
D. Names and addresses of owners of record of land immediately
adjoining and within 200 feet of the proposed exemption, mineral
owners and lessees of mineral owners of record of the property to
be exempted, and tenants of any structure proposed for
conversion; and
E. Evidence of the soil types and characteristics of each type; and
F. Proof of legal and adequate source of domestic water for each lot
created, method of sewage disposal, and letter of approval of
fire protection plan from appropriate fire district; and
G. If connection to a community or municipal water or sewer system
is proposed, a letter from the governing body stating a
willingness to serve; and
H. Narrative explaining why exemption is being requested; and
I. It shall be demonstrated that the parcel existed as described on
January 1, 1973 or the parcel as it exists presently is one of
not more than three parcels created from a larger parcel as it
existed on January 1, 1973.
J. A $100.00 fee must be submitted with the application.
��T o Petitioner Gerald W. Gal, ay
745 East Avenue
��j`d Mailing Adress
\K 0C1 Rifles Colorado 81650
1�1�� City State
`;�►-+� L'U 303 625 4045
Telephone Number
EXEMPTION
APPLICABIL,IT;Y.:
The Board of County Commissioners has the discretionary power 'to exempt a
division of land from the definition of subdivision and thereby from the
procedure in these Regulations, provided the Board determines that such
exemption will not impair or defeat the stated purpose of the Subdivision
Regulations nor be detrimental to the general public welfare. The Board
shall make exemption decisions in accordance with the requirements of
these regulations. Following a review of the individual facts of each
application in light of the requirements of these Regulations, the Board
may approve, conditionally approve or deny an exemption. An application
for exemption must satisfy, at a minimum, all of the review criteria
listed below. Compliance with the review criteria, however, does not
ensure exemption. The Board also may consider additonal factors listed in
Section 8:60 of the Subdivision Regulations.
A. No more than a total of four (4) lots, parcels, interests or dwelling
units -will be created from _any parcel, as that parcel was described in
the records of the Garfield County Clerk and Recorder's Office on
January 1, 1973, and is not a pact of a recorded subdivision; however,
any parcel to be divided by exemption that is split by a public
right-of-way (State or Federal highway, County road or railroad) or
natural feature, preventing joint use of the proposed tracts, and the
division occurs along the public right-of-way or natural feature, such
parcels thereby created may, at the discretion of the Board, not be
considered to have been created by exemption with regard to the four
(4) lot, parcel, interest or dwelling unit limitation otherwise
applicable;
B. All Garfield County zoning requirements will be met; and
C. All lots created will have legal access to 'a public right-of-way and
any necessary access easements have been obtained or are in the
process of being obtained; and
D. Provision has been made for an adequate source of water in terms of
both the legal and physical quality, quantity and dependability, and a
suitable type of sewage disposal to serve each proposed lot; and
E. All state and local environmental health and safety requirements have
been met or are in the process of being met; and
F. Provision has been made for any required road or storm drainage
improvements; and
G. Fire protection has been approved by the appropriate fire district.
H. Any necessary drainage, irrigation or utility easements have been
obtained or are in the process of being obtained; and
I. School fees, taxes and special assessments have been paid.
(The School Impact Fee is $200.00 for each new lot created).
PROCEDURES
A. A request for exemption shall be submitted to the Board on forms
pcovided by the Garfield County uepat tment or Development/Planning
Division. Two (2) copies of the application, maps and supplemental
information shall be submitted.
B. The Planning Division shall review the exemption request for
completeness within eight (8) days of submittal. If incomplete, the
application shall be withdrawn from consideration and the applicant
notified of the additional information needed. If the application is
complete, the applicant shall be notified in writing of the time and
place of the Board of County Commissioners meeting at which the
request shall be considered. In either case, notification shall occur
within fifteen (15) days of submittal.
C. Notice 'of the public meeting shall be mailed by certified mail, return
receipt requested, to owners of record of land immediately adjoining
and within 200 feet of the proposed exemption, to mineral owners and
lesses .:-of mineral owners of record of the land proposed for
exemption, and to tenants of any structure proposed for conversion.
The exemption site shall be posted clearly and conspicuously visible
from a public right-of-way with notice signs provided by the Planning
Division. All notices shall be mailed at least fifteen (15) and not
more than thirty (30) days prior to the meeting. The applicant shall
be responsible for mailing the notices and shall present proof of
mailing at the meeting.
D. At or within fifteen (15) days of the meeting, the Board shall
approve, conditionally approve or deny the exemption request. The
reasons for denial or any conditions of approval shall be set forth in
the minutes of the meeting or in a written resolution. An applicant
denied exemption shall follow the subdivision procedure in these
Regulations.
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Recorded altiv 'clock M , _4D
Reception No. Recorder.
THIS DEED, Made this 12th
19 88 ,between Gerald W. Galloway
day of May
of the County of Garfield and State of
Colorado, of the first part, and
Jerry Fazzi and Sharon K. Fazzi, as joint tenants
with right of survivorship,
whose legal address is
1090 214 Road, Silt, CO 81652
of the County of Garfield and State of Colorado, of the second part:
WITNESSETH, that the said part y of the first part, for and in consideration of the sum of Ten Dollars
and other good and valuable consideration
RRIXIMM
to the said party of the first part in hand paid by the said parties of the second part, the receipt whereof is
hereby confessed and acknowledged, ha s granted, bargained, sold and conveyed, and by these presents do es
grant, bargain, sell, convey and confirm unto the said parties of the second part, their heirs and assigns forever,
not in tenancy in common but in joint tenancy, all the following described lot or parcel of land, situate,
lying and being in the County of Garfield and State of Colorado, to wit:
Township 7 South, Range 92 West of the 6th P.M.
Section 22: NE4SE4 and E1/2NE4
TOGETHER WITH 7 shares of stock in the Highline Ditch Company and
the water and water rights represented thereby.
Grantor expressly reserves to himself one-half (z) of all oil,
gas, minerals and mineral rights in, on or under said property
and the right to sell, lease or remove same, (subject to reason-
able compensation for surface use and disturbance).
Grantor further reserves an easement for the ditches in place
serving-S'iSE4, Section 15, Township 7 South, Range 92 West, 6th
P.M., which easement shall be used and maintained according to
historical patterns predating the date hereof.
ALSO conveyed herewith are all ditches, ditch easements, ditch
rights-of-way and all other easements and rights-of-way
appurtenant to and used in connection with the property conveyed
hereby.
The property conveyed by this deed contains 120 acres more or
less.
OCTP;11- ' ',in'
li 18 1988
frau-HELL u u1Vlj
TOGETHER with all and singular the hereditaments and appurtenances thereunto belonging, or in anywise apper-
taining, and the reversion and reversions, remainder and remainders, rents, issues and profits thereof; and all the
estate, right, title, interest, claim and demand whatsoever of the said part y of the first part, either in law or equity,
of, in and to the above bargained premises, with the hereditaments and appurtenances.
No. 768.tVARRANTY DEED—To Joint Tenitnts.—Itriultord Publishing Co.,1821-46 Stout Street, Denver, Colorado — 11-77
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•
STATEMENT
A. Domestic water will be by drilling a well
B. Sewage disposal will be by an approved
installed septic system.
Gerald W. Gallowa date
List of names of adjacent landowners
Robert L.&Kathleen Hood
1898 Co Rd 324
Silt CO 81652
David P. & Alvera J. Howell
4560 Perry St.
Denver CO 80212
J. Gentry
0232 CoRd 265
Rifle CO 81650
THIS DEED, N.d.this first dad April .Irt 69
b.ewen GARLAND G. WYNN,also ktidwn app
G. G. WYNN of Frenchburg, Kentucky
EWAN
XmasWO. MILIONSIC11306Mak,.t the ttt.i ye a'
GERALD W. GALLOWAY
atm. County of Garfield am state d
Colorado, of the sewed pert:
WITNaSSWIN. That Vie add party of SIAM part. for and b eo ddaatlae of the sem of
Ten Dollars and other good and valuable considerations – - satmuiss
to the said party of the first pari in hand paid by said Party of the sawed part, the saa.yt o$laraat
hembp eonfeu.d and .ebmowl.dgsd, ba A granted, bargabW. sold sii—aaav lad. sod b7► Uwe pt'NMe i $ap ti
grant. b.rgain, sell. convey and confirm, unto the saki part y of the sifted parthis beim and sag= for-
mer, all the following daeribsd lot oe pared of had, spsate, 1phg dad being is the
Cowity os Garfield *and State of Cotoredo. to I
•
The NEkSEk, EtNEt, Section'22 and the SkSEk of Section 15,,
all in Township 7 South, Range 92 W. of the 6th'P.M. con -I
taining 200 acres, more or less, together with all water'
and water rights and ditches end ditch rights belonging to
and used in connection with said real property.
-Tocossaitmoivrigiks ahg.lee the hereditaments and apportmames thereto et in anywise
and mveesloos, r asaind r end rsmabefers. meta, saves sad thereof, and all
and demand wbatooenr of theadd part y of tie first put, either in lair
or a4 . to peeress, with the beordpassnte and appartrasseak
TO HAY= Alai TO *OLD tba wlh it s there bargained and dueribed with the app*rtenancss, onto tn.
said jlsrt y of the second pert,, hid_ bibs and assigns forever. And the said part y of the first part,
for Maid f , . his bin, amours. and admlestmton. does so eermt, grant, berg$m, and agee to red
vritb the said party_ of tb. seeps Park hisb.bs and with.. that at the tuner of the ma.aWg and delivery
of these preset;, he is well.-d:sd,ot the.ytmsse above aoa.;p.d, as of good, sere.' perfect, absolute and
16dsitirilEia 7i{dR at 7ebattmR; t hnn-triwlhyib sot bs-Zi good-rlght
tel, s 1,S datil, .en and convey the sane in mime and for aa aforesaid, and that the ems are tr.e and clear
"'•-frsa ell former and other grants, bargdae, ales, lies, tune, ,--.mama sod aneumbrangss otcirbstev.r kind oe
" immv r, except the 1969 taxes payable in 1970 which'Second Party
assumes and agrees to pay.
and the above bargained premises in tie quiet and peae.ablo pon.Woe of the mid part y of the ssesad part.
his heirs and assigns against all and_ may perm or p Lnifufl diodoa or..tnelaks thewh.N -
or any part thereof, th..aid part Y et the fret part shall aid will WARRANT AND FORMA DEFEND.
IN WITNESS WHEREOT, the said party of 'the tisat'psat hsa bwunte set 'his hand
and sal the day and per fiat .boys emittto.
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No. 952. WARRANTY DIrO,—rw r.Me.eetk r. race
rira4 ..
Produc e,s 88
Western Slates
Roc,- led at r --- _. ::l'� 15 IJO OCT, 1
Re i( Jo. 365741 MILDt L.i)
GARFIELD
OIL AND GAS LEASE
Paipc RECORDER
dirN'i Y, COLORADO
BOOK 677
5 1985
P E2O3
THIS AGREEMENT made this 13th day of August
GERALD W. GALLOWAY, a single man
10996 County Road.331.
Silt, Colorado 81652
t9 8 5 between
Lessor (whether one or more). and AMOCO PRODUCTION COMPANY. P_O_ !lox non, 1pnvnr,
Lessee, WITNESSETH:
1 lessor en consideration of
(
Ten and More
rnl nr�rin 8p2fl1
10.00+ Dollars
S ) en hand pard, the receipt and sufficiency of whech es hereby acknowtedged, of the royalties hereon prnwded, and of'the agreement o1 Lessee herein
contained., hereby wants. leas, and leis exc lusevety nolo lessee for the purpose of onvestegatenq. exploring. prospec Ung. drdhng and mmmg for and producing rod and gas/including, but not !emoted to.
gas producobte from coal -bearing lormateons) and all substances produced in assocuhon theeewrth, laying pope Innes. budding ranks. power stations, telephone Imes. roads and other structures
thereon to produce. save. take care of, treat. transport and own said products, and housing its employees. the following described land In
Garfield County, Colorado to wit'
Township 7 South, Range 92 West, 6th P.M.
Section 15: S}SE}
Section 22: E}NEI, NE*SEI
of Section XXXXXXXXXXXXXX XXXXXXXX Township XXXXXYXKXxxXj(XXXYYvYYYYYY Range XYYYYYYYYYYYYYYY•a•YVYYXYY
In addition to the land above described. Lessor hereby grants, I and lets exclusively unto L to the same extent as if specifically described herein all Lands owned Or claimed by
Lessor which are artracent, conhyuous to or form a part of the lands above particularly described. Including all roil, gas and all substances produced en association therewith underlying lakes, revers.
streams, rodtls.. easements and rights•of'way which traverse or adjoin any of said lands. Tor rental amens
acres..wheU.e ,t oc(ually comprises more or less. payment Durposes, the land igfluded within this lease shall be deemed to contain 200100
.. s'll five (5) G.W.G.�7:45/x/
2,., Sub�ectrto•Ihe other provisions herein contained, this lease shall be for a term oldie years from this date (called "primary term') and as long thereafter as oil, or gas es produced from said
lered.hwednder, or operationS for doffing or reworking are conducted thereon.
1i i.
•;S. 7f :era alsigsAo be pard by Lessee are: (a) on oil and olher Liquid hydrocarbons, one-eighth of that produced and saved from said land, the same to be delivered al the wells. or to the credit of
Lessor enlo the pipe tin, 10 which the wells may be connected; lessee may from time to Irme purchase any royalty oil ,n its possession, paying the market price therefor prevarbng for the held where
.produced on-rrie date of purchase; (b) on gas and the constituents thereof produced from said land and sold or used o11 the premises or en the manufacture of gasolene or other products therefrom, the
-mark etvalu.A, the wp` frune.eighth of INC produce so sold or used, provided that on product -sold at the wells the royalty shall be one•erghth of the amount realized from such sale. Lessee shall have
tree use•dl net i1asiatpl Nye er nom said land, except water from Lessors wells, streams, lakes and ponds, for all operations hereunder, and the royalty on oil and gas shalt be computed alter deducting
any so used.
•
,''%4, 11-a .well•capa l'o of producing gas in paying quantities is completed on the above described land and is shut ,n, this lease shall continue in effect for a period of one year from the date such
well ,s shut ,n; Le;see mill therealter, in the manner provided heron car the payment or tender of delay rentals. pay or tender to Lessor as royalty. on or before one year from the date such well es shut in,
an amount equal lo the rental, and, if such payment or tendo ,s made, such well shall continue This lease ,n effect lora lusher period of one year. In like manner and upon tike payments or tenders
annually made on or before each anniversary of the shut-in date of such well, such well shall continue this lease en effect for successive periods of twelve (12) months each. Notwethstandeng any other
provision to the contrary, this lease shall not terminale because of a failure to properly or timely make shut-in gas well payments unless Lessor shall have given L wrrlten notice of such failure to
properly or timely make such shut-in gas well payment and L shall have failed lora period of thirty (30) days alter receipt of such notice to tender such payment en the proper amount, together with
a lase or improper payment penalty of 5100.00.
5. I1 operations for drilling are not commenced on said land as hereinaher provided, on or before one year from this date, the lease shall then terminate as to both parties, unless on or before
First National
such anniversary date Lessee shall pay or tender to lessor or to the credit of Lessor in
P.O. Box 908. Glenwood SDri cis. CO 81602
Bank
(which bank and its successors are Lessor's agent and shall continue as the depository for all reenkntals
payable hereunder regardless of changes in ownership of said land or the rentals either by conveyance or by the death or incapacity of Lessor) the sum of Twn Hrinr3rPrl
and no/100 *****
dollars (S 200.00 *****
rivilege of deferring commencement of
operations for drilling for a period of twelve (12) months. In like manner and upon like payments or lenders annually the commeancement l), of operationwhich shall s forr drthe dhng may be usher deferred toe successive
periods of twelve (12) months each during the primary term. The payment or tender of rental herein referred to may he made ,n currency, draft, check or by electronic funds transfer at the o91,on of the
Lessee; and the deposrhng of such currency. draft or check en any post office, properly addressed to the Lessor or said bank. or the transfer o1 such funds to said bank on or before the rental paying date,
shall be deemed payment heron as provided. 11 such bank (or any successor bank) should lad. hquilate or be succeeded by another bank, or for any reason fad or refuse to accept rental. L shall not be
held on default fur failure to make such payment, tender or transfer of rental until Ihir4,(30) days after lessor shall delver to lessee a proper recordable instrument, naming another bank as agent to receive
such payment. lender or transfer. The down cash payment es consideration for this lease according to its terms and shall not be allocated as mere rental for a period. Lessee may at any Irme execute and
deliver to Lessor or o the depository above named or place of record a release or releases covering any portion or ponrons of the above described premises and thereby surrender this lease as to such
portion or ponrons and be relieved of all obligations as to the acreage surrendered, and thereafter the rentals payable hereunder shall be reduced en the poportron that the acreage covered hereby os
reduced by said release or releases.
If lessee shall. on or before any rental date make a bona fide attempt to pay or deposit a rental payment due hereunder, and if such payment or deposit shall be erroneous en any regard (whether
deposited in the wrong depository, paid to persons other than the parties entitled thereto, in an incorrect amount. or otherwise). Lessee shall be unconditionally obligated to pay to such Lessor the
rental properly payable for the period involved- but this lease shall be maintained in the same manner as if such erroneous payment or deposit had been properly made, provided that the erroneous
payment or deposit be corrected within shiny (30) days alter receipt by Lessee of written notice from such Lessor of such error accompanied by any documents and other evidence necessary to enable
Lessee to make proper payment.
6. Should any well drilled on the above described land during the primary term before production is obtained be a dry hole, or should production be obtained during the primary term and
thereafter cease, then and in either event. of operations for drilling an additional well are not commenced or operations for reworking an old well are not pursued on said land on or before the lust rental
peony date next succeeding the expiration of snly(60) days after the cessation of production or drilling or reworking operations on said well or wells, then this lease shall terminate unless Lessee, on or
before said date, shall resume the payment of rentals. Upon resumption of the payment of rentals, Section 5 governing the payment of rentals. shall continue en force lust as though there had been no
Interruption on the rental payments. If during the last year of the primary term and poor to the discovery of oil, gas, or other hydrocarbons on said land Lessee should drill a dry hole thereon, or if after
discovery of oil, gas or other hydrocarbons before or during the last year of the primary term the production thereof should cease during the last year of said term from any cause, 50 rental payment or
operations are necessary in order to keep the lease en force during the remainder of the primary term. If at the expiation of the primary term Lessee is conducting o9arabons lot drilling or reworkeng on
this lease 0, shall have completed a dry hole thereon wethen one hundred twenty( 1 20) days poor to the end of the primary term or, el. atter the expiation of the primary term, production on Ihrs lease shall
cease. this lease nevertheless shall continue ,n force so long as operations for drilling or reworking on any existing or succeeding well are being conducted with no cessation of more than one hundred
Twenty (120) consecutive days and. it such operations result In production. so long thereafter as oil or gas es produced from this lease.
7. Lessee, at its option, is hereby given the right and power to pool or combine the land covered by this lease, or any Donlon thereof. as to oil and gas, or either of them, with any other land,
tease or leases when In Lessee's lodgment it ,s necessary or advisable to do so on order to properly develop and operate said premises. such
pooling to be Into a well und or units notand sexty(160) acres. plus an acreage tolerance of ten percent (10%) of one hundred and viny(160) acres, tor oil, and not exceeding sex hundred and forty(640) acres, plus an acreage eueance one Dundee.
(IO%)ofSok hundred and forty (640) acres for gas, except that larger units may be created or.nlornrtoany spawn div ell sortyepe° by governmental itierhay.nof gtenpeteon,
Lessee may p,..)I or cor^.•;ire acreage covered by this 'ease, or any portion thereof, as above provided, as to odor gas en anyone or more strata. and units so formed need not conform m ore orareawith
the unit nr units into which the lease is pooled or combined as to any other stratum or strata, and ml units need not conform es to area with gas units. The pooling In one or more instances shall not
exhaust the rights of the Lessee hereunder to pool this lease or ponrons thereof into other units. Lessee shall execute ,n writing and place o1 record an instrument or instruments identifying anddescrebeng
the pooled acreage. The entire acreage so pooled into a unit shall be treated for all purposes, except the payment of royalties. as i1 rl were Included In this lease, and drilling or reworking operations thereon
or production of cd or gas therefrom, or the completion thereon of a well as a shut-in gas well, shall be considered for all purposes except the payment of royalties, as if such operations were on or such
production were from or such completion were on the land covered by this lease, whether or.not the well or wells be located on the premises covered by this lease. In lieu of the royalties elsewhere
herein specified. Lessor shall receive from a unit so formed, only such po0ion of the royalty stipulated herein as the amount of hes acreage placed In the unit or his royalty interest therein bears to the total
acreage so pooled ,n the particular unit Involved. Should any unit as originally created hereunder contain less than the maximum number of acres hereinabove specified, then Lessee may at any time
thereafter, whether before or after production is obtained on the unit, enlarge such unit by adding additional acreage thereto, but the enlarged unit shall on no event exceed the acreage Content
hereinabove specified. In the event an existing unit ,s so enlarged Lessee shall execute and place of record a supplemental declaration of unitization identifying and describing the land added to the
existing umt; provided, that ,1 such supplemental declaration of umuzalion is not bled until alter production ,s obtained on the unit as originally created. Then and en such event the Supplemental
declaration of notice of shall not become effecue until the first day of the calendar month nail following the filing thereof. In the absence of production Lessee may terminate any unetued area by
declaration
of record nonce of shall of be
see
ve the
developm 8 t or operation s all ha ed Dyght t undue. tool, authority combine
sad or anyr m time art 1I the
tiabove
ewdescribed I elands with other lands en the same general area by entering into a cooperative or and plan of
the terms, conditions, and provisions of this lease shall be deemed modified to conform to the terms, Conditions, and provisions of such approved
Dproval. to modrly, change or lermn:a le any such plan or agreement and. en Such evens.
and, particularly, all drdhng and development requirements o1 this lease, express or implied, shall be satisfied by compliance with the cooperative l pmt plan of development u hopl afro r
agreement. and this lease shall not terminate or expire during the Ide of such plan or agreement. In the event that Said above described lands or anydolling pan and thereof, shall
requieme operatedof edch plan or
such cooperative or unit plan of development of operation whereby the production therefrom es allocated to different ponrons of the land covered by said plan, then Cheep oducbon loeat d to any
Danrcular lead of land shall, for the purpose or computingdhe royalties to be paid hereunder to lessor, be regarded as having been produced from the pamcutar tract of land to which 1115 allocated and
nit to any other tract of lend; and the royally payments to be made hereunder to Lessor shall be based upon production only as so allocated. Lessor shall formally espress lessor's content 10 any
cooperative or unit plan of development or operation adopted by Lessee and approved by any governmental agency by executing the same upon request of Lessee.
9 Lessee shall have the right at any time without lessor's consent to surrender all or any portion of the leased premises and be relieved of all obligation as to the acreage surrendered. lessee
shall have the right within a reasonable time alter the expiation of this lease to remove all properly and h.lures placed by Lessee on said land, Including the right 10 draw and remove all casing. When
requerd by Lessor. Lessee will bury aft pipe hoes below ordinary plow depth, and no well shall be drilled within two hundred (200) feet of any residence or barn now on said land without Lessor's
consent. The Lessee agrees to promptly pay to the owner thereof any damages to crops, or improvements, caused by or resulting from any operations of Lessee.
Corm 1779 .hen.R1 IS" • ,u L '81 ,( sc P
WRJ-5-Rev. 76
Application must
be complete where
applicable. Type or
print in BLACK
INK. No overstrikes
or erasures unless
initialed.
CSIADO DIVISION OF WATER RESOD
818 Cen ennial Bldg., 1313 Sherman St., Denver, Colof;E 80203
FOR:
PERMIT APPLICATION FORM
A PERMIT TO USE GROUND WATER
► A PERMIT TO CONSTRUCT A WELL
A PERMIT TO INSTALL A PUMP
REPLACEMENT FOR NO
) OTHER
WATER COURT CASE NO
(1) APPLICANT - mailing address
NAME G,<61/ 2 v i J/o t-0 R y
STREET
De,./z_ a.,e,P_ /6
CITY S//4 co%o
(State)
e/z,s�z
(Zip)
TELEPHONE NO X76 -2V7‘,
(2) LOCATION OF PROPOSED WELL
County -(,2/41-/E--1P
Sw:
'/ of the .S C '/< Section /-S
c
Twp. �, Rng. 1 Z
[)
IN,S) (E,W)
6-6.4 P.M.
(3) WATER USE AND WELL DATA
Proposed maximum pumping rate (gpm) / �qP�
//F
Average annual amount of ground water
to be appropriated (acre-feet) •
Number of acres to be irrigated:
Proposed total depth (feet):
Aquifer ground water is to be obtained from:
4y
Owner's well designation
GROUND WATER TO BE USED FOR:
(X) HOUSEHOLD USE ONLY
( ) DOMESTIC (1)
( ) LIVESTOCK (2)
( ) COMMERCIAL (4)
no irrigation (0)
( ) INDUSTRIAL (5)
( ) IRRIGATION (6)
( ) MUNICIPAL (8)
( 1 OTHER (9)
DETAIL THE USE ON BACK IN (11)
(4) DRILLER
Name --0(1•107c---S-
Street
0(1✓01c"�
Street
/r5 o
City /?4/c -7. -
C�,aP11: 93
�.o )o /6Sr�
(State) (Zip)
TelephoneNo.6Z5 -/sLZ) Lic.No ler
FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN
Receipt No /
Basin Dist.
CONDITIONS OF APPROVAL
This well shall be used in such a way as to cause
no material injury to existing water rights. The
issuance of the permit does not assure the applicant
that no injury will occur to another vested water
right or preclude another owner of a vested water
right from seeking relief in a civil court action.
APPLICATION APPROVED
PERMIT NUMBER
DATE ISSUED
EXPIRATION DATE
BY
(STATE ENGINEER)
I D COUNTY
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1,/
SB 35 EXEMPTION CHECK SHEET
Deeds for Ownership
Deeds showing number of lots created since January 1,
1973.
List of names of adjacent landowners and owners within
200'.
List of mineral owners and lessees of mineral owners of
record of the property.
Soils information.
Source of legal and adequate water supply.
Method of sewage disposal.
Letter concerning fire protection from appropriate fire
district.
Letter from appropriate municipality, if parcels are to
be served by municipal water and/or sewer.
Narrative explaining why exemption is being requested.
Sketch map scale 1'=200' showing legal description of
property, dimensions and area of all lots or separate
interests to be created, access to public
right-of-ways, proposed easements for drainage,
irrigation, access or utilities.
Vicinity map scale 1'=2000' showing general topography
and geographic relation of proposal within 2 miles.
Letters sent 15 days prior to hearing for adjacent
landowners within 200'.
Letters sent 15 days prior to hearing for mineral owner
of property.
Property posted.
$100.00 Fee
z.',) eAd _,--. 1,4)&14 C/ 3i