HomeMy WebLinkAbout1.21 Well Permit,�i, i%l ica ii on must
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COLORADO DIVISION OF WATER RESOURGL:S .
818 Centennial Bldg., 1313 Sherman St., Denver, Colorado 80203
PERMIT APPLICATION FORM
(x) A PERMIT TO USE GROUND WATER
(X) A PERMIT TO CONSTRUCT A WELL
FOR: (X) A PERMIT TO INSTALL A PUMP
( ) REPLACEMENT FOR NO.
( )OTHER
WATER COURT CASE NO.
(1) APPLICANT • mailing address
NAME Oil i 2 I C K � • t' -i /4 V,-
S
STREET � ��/S 2 /�/ /<V,
CITY A/IE= I-✓ Coi=l S T -I r=- CU
(State)
(Zip)
TELEPHONE NO. �y�/' 2 YS o ' C78y- 2 i / 2-
(2) LOCATION OF PROPOSED WELL
County G !-1 F_ o
L 3
of the IV [,v y,, Section
y
Twp. —S. Rng. _ �/ / G</
lv 7A/ P.M.
(14,S) (E,IVI
(3) WATER USE AND WELL DATA
roposed maximum pumping rate (gpm) / S 6'101'1
Average annual amount of ground water
to be appropriated (acre-feet): L Q
Number of acres to be irrigated: %yory e
Proposed total depth (feet): CS �'in,« fe 2 00 -C7,
Aquifer ground water is to be obtained from:
Owner's well designation /lot y 0 G[J e
OUND WATER TO 11E USED FOR:
(: HOUSEHOLD USE ONLY . no irrigation (0)
DOMESTIC (1) ( ► INDUSTRIAL (5)
( ) LIVESTOCK (2) ( 1 IRRIGATION (6)
( I COMMERCIAL (4) ( ) MUNICIPAL (8)
( 1 OTHER (9)
DETAIL THE USE ON BACK IN 01)
(4) DRILLER
Harne
-'treet 6-0 6 Z // 3 2d
City G•/r N.cIC-c•c/ Sp,-,,._,, -f
(State) (Zip)
Telephone No./qs- S/�J�. Lic. No. 6;n 7 7
REC�1'
MAR 1 � �gRfj
41ATE8 ItESO''' . �`
$tA7E ENGb
COLO
FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN
Receipt No. ,P- 5 5 /
Basin
XM
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.
APPROVED FOR HOUSEHOLD USE ONLY, FOR ONE
(1) SINGLE FAMILY DWELLING AND NOT TO BE
USED FOR IRRIGATION. THE RETURN FLOW FROM
THE USE OF THIS WELL MUST BE RETURNED TO
THE SAME STREAM SYSTEM IN WHICH THE WELL
IS LOCATED.
APPLICATION APPROVED
Li 3336
PERMIT NUMBER
DATE ISSUED MAR -20 1980 .A'7; t'
MAR 2 0
�EXPI�ON DATE 1982- � •�t'�::�:�,k}�;
r�
i..
(S A E ENGI R
BY
I.D._�� COUNTY_ ``s'419AA