HomeMy WebLinkAbout20030808.tiff Sep 27 02 09: 05a 970 392 1816 p. 2
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MAY 1 3 1982 1
.17\i'F. rrL':iG.W ) SS ' (i).�.` a am=IIMMI Mow= 'I
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COiUIITY OP D-enVG{r ) fJn
ir :• riPi iall:.(r.. ) : ..54 1--. �0L----Con ti _ .. '•'Et.:
mr'i I in'I .:.l,Jrc•,; „e: Caa ":at rt �-c7.. . . .
A
/- r t41—_—
7//YD ) , being duly sworn upun :•::C:.
(sta te l tip code
and saw: thr.:; he i the owner of the following described ;::"+t,5r•.y
Si t'nne in the County of W_st_ , State ci'
Colorado: ( insert 1egr1 iIQ cri nti on or attach Hereto)
Sa r la - oz, sue,•1i 24- -t u) L$J 4 &3 CO 6 P"7 .
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Further, the affiant(s) deposes and says that he has read the 'stateranti
made herein; knows the contents hereof; and that the same are true of his
own znowledge. r.141a --411
Subscribed and sworn to before me this //,7 day of „" • l 'n.
P4`r Canmission Expires July 31,rw.-
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My Commission expires:
• otary P lic
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e--i-10-7:
2003-0808
Sep 27 02 09: O5a 970 392 1816 p. 3
i
., s.$e..76 COLORADO DIVISION OF WATER RESOURCES
_ 818 Centennial Bldg.,1313 Sherman St.,Denver,Colorado 60)3 R
PERMIT APPLICATION FORM •
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. RECEIVED
Application must MAY 1 3 19pp�
82
be complete where I A PERMIT TO USE GROUND WATER
applicable, Type or ( A PERMIT TO CONSTRUCT A WELL SW mantra
print in BLACK FOR: ( 14'A PERMIT TO INSTALL A PUMP WIZ UR
INK.No overstrikes WA
or erasures unless ( 1 REPLACEMENT FOR NO.
initialed. ( .1 OTHER _
WATER COURT CASE NO.
(1) APPLICANT - mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN
NAME &'44n — O. ( E Receipt No.vS&2 6g l
STREET c�p�p ' 1._.btO c2t (0 I Basin 5 Dist. .9
CITY SI<Ye>}Qa LA ?( l Z 000NDITIONS OF APPROVAL
(slaw) Il gyp)
TELEPHONE NO. This well shall be used in such a way as to cause
no material injury to existing water rights. The
(2) LOCATION OF PROPOSED WELL 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
County LOS Lt5 right from seeking relief in a civil court action.
L
St Y. of the S l t� Section 24-
(r, TAE A4f0UNTT:.F
P.M. IS NOT CONI)EAE10 To I Z MAT I:1 ACRE-F€ET
Twp. ri� , Rnq. _ MAT-IN A TO Th7;
in.sr it"
TER1fS OF S pgR){1T PURSUAN
(3) WATER USE AND WELL DATA STATUTES, 1973, 37-90-105, T TO COLORLDC
Proposed maximum pumping rate(gpm) Sett Pap #4 . NOTICE
Average annual amount of ground water 1 CASING INSTALLED IN THIS WELL SHALL NOT
to be appropriated (acre-feet):
EXCEED SIX (6) INCHES IN DIAMETER.
Number of acres to be irrigated! ---
Proposed total depth (feet): iStivrASA Iam
Aquifer ground water is to be obtained from:
Owner's well designation
GROUND WATER TO BE USED FOR:
( I HOUSEHOLD USE ONLY• no irrigation (01
( ) DOMESTIC (II ( I INDUSTRIAL IS)
I 1),IVESTOCK (2) I I IRRIGATION I6)
(set COMMERCIAL (41 ( ) MUNICIPAL(8)
( 1 OTHER I9) APPLICATION APPROVED
DETAIL THE USE ON BACK IN(1l) 125420
PERMIT NUMBER 1� �.c4RR�� rat
(4) DRILLER eel t DATE ISSUED Ju 18 1982
Name It1 F.\C a EXPIR N DATE MAY 18 984
^
Street C✓1 [i
City s s ant (STAT ENGINE )
(Stand IZIa) �s // )__.-2-K1,7/sytTelephone No. _. Lic. No. 9_
I.D. I - 40i COUNTY (O
Sep 27 02 09: 05a 970 392 1816 p. 4
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(5) THE LOCATION OF THE PROPOSED WELL and the area on (6) THE WELL MUST BE LOCATEQ BEL
which the water will be used must be indicated on the diagram below. by distances from section lines-Use the CENTER SECTION (1 section, 640 acres)for the well location.
/Sail ft.from 5 sec.line
+ — -1- — -+. f — +— + — --F — T — -4-. 1nat11 et 1001111
1 .4-----1 MILE.6280 FEET--) I .255-A ft.from Ill to or west)
sec.line
F + + ± I LOT ...BLOCK FILING is
I I i I
+ - 4 _ t NORTH SECTION LINE —
+ — SUBDIVISION
I I.
( I I (7)TRACT ON WHICH WELL WILL BE
+NORTH LOCATED owner:
i — T - T - + - -> + + No.of acres .Will this be
J vi
I z I I se
o m I the only well on this tract?
n
+ t 2 I z --- + (8) PROPOSED CASING PROGRAM
% r- I Plain Casing
T '� - - -i- - X — "" ± f el. in.from a ft.to r ft.
I I 1
1 in.from h.to h.
.- - + _ I I - _ -4_ _ i Perforated casing SOUTH SECTION LINE 7Nr ft. t0 �� ft.
I I I I 5 —in.from
+ + + -3-- -I- -* 4 4- 4- in. from tt.to H.
I I I (9) FOR REPLACEMENT WELLS give distance
and direction from old well and plans for plugging
4- - _4- - -4 - -f- - -}- - - - - + - - 4- it:
The scale of the diagram is 2 inches= 1 mile
Each small square represents 40 acres.
WATER EQUIVALENTS TABLE (Rounded Figures)
An acre-foot covets 1 acre of land 1 foot deep
I cubic loot per second Ic sl ...449 gallons per minute(gpm)
A family of 5 will require approximately 1 acre-loot of water per year.
1 acre-foot...43.560 cubic feet...325,900 gal ions.
1,000 ppm pumped continuously for one day produces 4.42 acre-feet.
(10) LAND ON WHICH GROUND WATER WILL BE USED'
owner(d: No.of acres:
Legal description:
(11) DETAII.Fsffla�ysSCRIPTION of the use of ground warer: Household use and domestic wells must indicate type of disposal
system to be used. i�1 t. 0 / ,7� /
Jbesr...e.a 6/�yJ/ ls—N /T�.^ai
�v
(12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers.
Type or right Used for(purpose) Description of land on which used
(13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS
TRUE TO THE BES . OF HIS KNOWLEDGE. G
Sr TUNE OF APPLICANT(SI
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Use additional sheets of paper if more space is required. ,
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