HomeMy WebLinkAbout23. Well PermitForm No.
t3WS-11
08/2018
COLORADO DIVISION OF WATER RESOURCES
DEPARTMENT OF NATURAL RESOURCES
1313 Sherman St., Ste 821, Denver, CO 80203
Main: 303,888.3581
dwrpermltsonllne@state.co. ue
For Office Use Only
CHANGE IN OWNER NAME/MAILING ADDRESS
PRIOR TO COMPLETING THIS FORM, SEE INSTRUCTIONS ON REVERSE SIDE INCOMPLETE, POOR
QUALITY, OR ILLEGIBLE FORMS CANNOT BE PROCESSED AND WILL BE RETURNED
Name. address and phone number of person claiming ownerst2ip of the well permit:
Name(e):
Mailing Address:
City, St, Zip:
Phone:(970)
RFLANDCO, LLC, A COLORADO LIMITED LIABILITY COMPANY
402 PARK AVE UNIT A
BASALT, CO 81821
927-4383 Email: JACKOALBRIGHT-ASSOCIATES.COM
Will Permit
WELL LOCATION;,
Number:48838 Receipt Number: Case Number(optlonal):
County:Qerfleld Well Name or # (optional):JACK D & ELOISE H IL.GEN
17352 HIGHWAY 82, CARBONDALE, CO 81823
Street Address at Well Location
Check If well address is same as owner's mailing
5E '�. of the NE 1/4, Sec,32 , Township 7
address
P,M.
N. or 1_1 S. Range 87 E, or 0 W., BTH
Distance from
Subdivision Name
NOTE: If changing/correcting
Section Lines:2900
(If applicable):
Ft. From N. or a 6. Line, 200 Ft.
From F.1 E. or W. Line.
, Lot , Block , Filing/Unit
the permitted location of a well, use Form No. GWS-42
I (we) claim and say that I am (we are) the owner(s) of the well permit described above, know the contents of the statements made herein,
and state that they are true to my (our) knowledge. This filing Is made pursuant to C.R.S, 37-90-143.
Signatures) of the new ow
-
Please print the Signers Name & titre
`l Y A
ihrt - I--
Data
July 30, 2020
It Is the responsibility of the new owner of this well permit to complete and sign this form. If an agent Is signing or entering Information, please
see Inetruetione.
Please allow 4 to 8 weeks for processing of this form. Thereafter, you can view or print the accepted document at:
httplIwww.dwr.state.co.us/WellPermitSearch
Signature of DWR staff indicates acceptance as a Change In Owner Name andror Mailing Address.
For Staff Use Only
Staff Signature pate
Form 314 closing/welLtranefer,html
84003281
(100083387)
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