HomeMy WebLinkAbout20071423.tiff COLORADO DIVISION OF WATEI :SOURCES Office Use Only r Form OWS-45(0612006)
DEPARTMENT OF NATURAL RtSOURCES
1313 SHERMAN ST, RM 818, DENVER,CO 80203
phone—info:(303)866-3587 main:(303)866-3581 fax: (303)866-3589
http://vAvw.water.state.00.us
GENERAL PURPOSE
t ter Well Permit Application
Review Instructions on reverse side prior to completing form.
The form must be completed in black or blue ink or typed.
1. Applicant information 6.Use Of Well (check applicable boxes)
Name or spa rn Attach a detailed description of was applied for.
CONQUEST DISPOSAL SERVICE ❑Industrial Ott►sr(dewlap):Mitwe address _.
_ .—' O Municipal
8203 W.20TH STREET,SUITE A O Inigation
_-... Ts s rzlpeod. Z Commercial
GREELEY
E
CO 180634 7.Well Data (proposed)TWophon.tilt .. E-mail ..._.._-....._ .. ..
- {opus► _.......
(970)356-5560 ...._ . ._. - ..Ann -...............__..._......_._....
acre-feet
mown"pumPir>o hale ` Arran amount b w*McMinn
2.Type Of Application (check applicable boxes) 15 1/3
Tote)
® Construct new well O Use existing well Aquifer
❑Replace existing well ❑Change or increase use 370 feet FOXHILL
❑Change source(aquifer) O Reapplication(expired permit) 8. Land On Which Ground Water Will Be Used
Other Legal peon{rosy tta provided as an aaeohtttati);
3. Refer To(if applicable)
Well permit I water Court case -I
t
Designated Benin Determination is Nu**rumor*
•
4. Location Of Proposed Well
County (X used for trop Option,attach a scaled Tap that shows irrigated area.)
WELD ' SE 1/4 of the SE iN A. rams i B. ottmr
Section • • Tomah") N or S Rams E or W Prktdpd Mrldlen
II
_.....---_—.... .
p^ L65 0 IN C. tint awry Whet web few.esr rights used on ri.tenth
• Di.. .of wets from asetton anee iereen tees s v typo*not proper-1i lbws)
908 Ft.from p N®S 1112 ft-wom®E❑w.. 9. Proposed Well Driller License#(optional):1397
For replacement wells only-distance N;adimotion;,o,r;.oe„el to new well . 10.Signature Of Applicants)Or Authorized Agent
feet di• rection __..---_-._-- . •---- _.._._..__._... _ _.
The making offalse statements herein constitutes perjury in the second
well iocetcn merest(Include city.state,Zip) in check rsat address is stem as In tam 1. degree,which is punishable as a class 1 misdemeanor pursuant to C.R.S.
24-4-104(13Xe). I have read the statements herein,know the contents
thereof and state that they are true to my knowledge.
Sign here(Meet be +�
Deis
O quilled l: ting as location Information in tf fM kxmst You must txtadt t3PS tint for ��] % � I
required settings as f011Dvtrs /9�7
t - f,/Format must be UTM rtenta 8
❑Zone 12 a❑Zone 13 Farting Q\i WOCA19e07 / of/7
Units must be Meters
Datum heat be N�10°' Northing Office Use Only
Unrt must be sotto true north USGS map name : DWR map no. Surface elev.
Was OPS unit checked nor above? ❑YES Remember to set Datum to NAD33
5. Parcel On Which Well Will Be Located Receipt area only
(PLEASE ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL)_
A. Legal Description(may be provided es en auaulatwi • Ij
•
•
B. Call ems In pared I C. Owner WE
80 I CONQUEST DISPOSAL SVC. wra
aNy well onaM Mower?OYES ONO Ono—IN altar webs) CWCB
TOPO
E. Mole Penal ID/Wean* frf AR
SB5 DA/ WI) BA MD
2007-1423
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t�,�.`Y ,.\\ ,.:---- S„ r,)• o.`! M tSMldmill m . ,', ...t.''. ,:,-.--4`\ '
�`f 1 �� } e., - ( , ..DOS FROM THE SOUTH SECTION LINE 1112 FROM THE EAST SECTION UN EL `\`
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i 3-O TnqurOuadc('nmright'e'1499 Delarme I.smooth,ML O4l96 Sure Data;1'CGS Mt ft kale;1:ZS,OINI Driail:13-O Datum:N ID:7
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