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Home My WebLink About20110080.tiff MAY-28-2009 THU 09:52 AM W C VIRONNENTAL HEALTH FAX NO. 970 304 8411 P. 01 An SF.ALm DEFEC � • E-910 o i /g SENTV ►l. PROTECTION SERVICES �;i.4-� LAN . .6th Avenue Court R-4 ISDS f_ • Rey. Colorado 80631 Weklthca...'J _ BEMIS !)353-0635 jr:c a c c I STATEMENT OF EXISTING FOR SEPTIC SYSTEM fit.(' ; S9gf , (PLEASE FILL OUT IN BLACK INK ONLY) OWNER OF RECORD: *MA& AN® NIL&Fp 341 2- PRONE: / 760) -2,53- 7744 MAILLYG ADDRESS: /y0 9y tecP 22- f T L1 at/ ado 60 621 city State Zip srIE ADDRESS: /4414 06_12' 22 F re Luf Ot rean/ t'm�c. 8142/ City LEGAL DESCRIPTION: PT:_ PT:kE4 SECTION: lip TOWNSffiJAM/P:_ RANGE: JA / SUBDIVISION: /44/4. LOT:_ BLOCK:_ FILING:• MISER OF PEOPLE: BEDROOMS: 4- BATHROOMS: / WATER SUPPLY:Isseht, ESIDENTZ7iLJ / COMMERCIAL BASEMENT PLUMBING: Y ( 1 LOT SIZE: Pep acres SYSTEM SIZE: Tank is constructed of Centel and has 2 oon gallons capacity (material) FIELD: Bed or Trench /00 0 square feet. DATE_ TSTU1 INSTALLED:U'h'fQwf• • Tan are requital to draw a diagram. of the system cu the reverse side of this foss in black ink only and indicate location, length. width, and distance Pram the duel-ling- The undersigned property owner hereby certifies that the above described septic system is in fact installed, as described, and exists at this time on the parcel of ground identified by the above legal description and further states that the system is in good working order and to the best of his/her knowledge is not failing to function properly. I further understand that any falsification or misrepresentation may result in revocation. of any permit granted based upon this information hereby submitted and in legal action for perjury as provided by law. Sr Z ?.1L9'9CM"v� V A}da P Date ler? Owner Subscribed and sworn to befo .me-this " ' A - •" da ^^Effl 4e-- , 1992. --.. Witness my hand and official seal, aloe expi Se sea 1Q/9 . . .oFFr ail • Date NORMAN 0RFKi. Notary _? h COMM.II 7030175 Notary x ►i SAN BERR.W °mUN fornla b COUNTY 2011-0080 STATRtENT OF EXISTING ;� r ,•. :'" Au`c'us s ge t TniiThSeatal Protection S. rim 11 It MAY-28-2009 THU 09:53 AM W C IRONMEN1AL HEALTH FAX NO. 970 6411 P. W a s. . a G,`�nn gap It • i -_ • iZ7s00 at. s • a'C X. . • • • r-..yam ._ m — j, oAiCA • y F. • 3S'' 4.4 - . e•i-r 4a+flk-`mitt( . 0wx • • - _.r , ;. - . • WRJ•S-Rev. 76 COL DODIVISION OF WATER RESOURC L� RECEIi D 818 Centennial Bldg., 1313 Sherman St., Denver,Colorado'80203 JUN 15 78 PERMIT APPLICATION FORM WATER RESOURCE& illrpplication must " SLATE EMI= e complete where (ic) A PERMIT TO USE GROUND WATER COS applicable. Type or (x) A PERMIT TO CONSTRUCT A WELL print in BLACK FOR: (XI A PERMIT TO INSTALL A PUMP INK.No overstrikes p Cy/ or erasu es unless 7C REPLACE ENT FOR N9, q„ �. lie / initiate . ( 1 OTHER,'E� �¢ C HG "9� EC�OKCl/ WATER COURT CASE NO. 23-t1 ( APPLLIICANT-mailing address ss �� / / FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN C/A NAME �7•,I e4 • KiLe,/1iv1✓J ltd Receipt No. t7" 7 y° / STREET/4/Y ? " we At /CEO R/ -2_2_ . Basin Dist. CITY/ .Ai/i" (State) O2 (I Z/ CONDITIONS OF APPROVAL TELEPHONE NO. D sP .Z .'3 ' 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 Countty/ VV�� !1 right from seeking relief in a civil court action. �J /7 V/ %4 of the lyre �z,Section //‘ in 's ..�Mg �/ • Twp. EC,Rng.-4lp �, h P.M. tTt'I.,,., ..must inset..us ED (N,S) (Eva ACCORDING TO THE REVISED AND AMENDED RULES AND (3) WATER USE AND WELL DATA REGULATIONS FOR WATER WELLAN./PUMP INSTALLATION CONTRACTORS. THE ENCLOSED AFFIDAVIT MUST BE ID Proposed maximum pumping rate (gpm) O SUBMITTED WITHIN SIXTY(60NDAY$.AFTER THE CONSTRUCTION OF THE NEW WELL,,AFFIRMING THAT Average annual amount of ground water / WELL NO. i-g 96 7 WAS PLUGGED AND ABANDONED. to be appropriated (ape-feet): Number of acres to be irrigated: / Proposed total depth (feet): ,56-'4O Aquifer ground water is to be obtained from: Owner's well designation • GROUND WATER TO BE USED FOR; ( ) HOUSEHOLD USE ONLY- no irrigation (0) ()C DOMESTIC (1) ( 1 INDUSTRIAL (5) ( 1 LIVESTOCK (2) ( ) IRRIGATION (6) 1 1 COMMERCIAL (41 ( 1 MUNICIPAL (B) I 1 OTHER (9) APPLICATION APPROVED DETAIL THE USE ON BACK IN (11) / �f /� PERMIT NUMBER 2 e p /e( / —/ (4) DRILLER DATE ISSUED JUN 71 Name R� 9 1 5e Da/x"e y� , EXPIRATII0-N DATE JUQ street !� (9v l !J " C 4 1°.W /7v-C2 4.Q/t,u, . •City Mtn 07411<SIJ?1_ 90//1. O&40 ,t;Q,g . (STATE ENGINEER)GI � , ,(/Stara iro Q' r y SO,i BY Telephone No..2�!) O �/ Lic. No, n np I.D. /1.'412- COUNTY v i . . • , • (5) THE LOCATION OF THE PROPOSED WELL and the area on (6) THE WELL MUST BE LOCATED BELOW 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. ` • + — -I-- - ± — +' — —1— -- -4- — __i_ — —)- — --- (U Q ft.from / rth O sec. line ( o7 or south) i 1Af-----1 MILE,6280 FEET--+i I ADD ft.from Ebs7" sec. line (east or west) f + 4- . + + + ± + + LOT BLOCK FILING • ` I 0 . NORTH SECTION LINE — ± — SUBDIVISION 4 I I I I (7) TRACT ON WHICH WELL WILL BE NORTH1� f�� t�� LOCATED OOwnerrE el.;fl./(21 Yr AAQj '{' T z — T — — — T — —D _ ± ± No.of acres 410 - Will this be 22-, l t� g • m I the only well on this tract? 1/P ,5 H + ± y I I o — + (8) PROPOSED CASING PROGRAM z I y I. I r II Plain Casing + + k- - -I- _ - .m + T .7," % in.from+ / ft. to l0 0 in.from ft. 1I �� ft.to 9>0 ft. -I— — + i SOUTH SECTION LINE I I I 4— 4. - I Perforated casing /�2 `7/ r�in.from / O ft. to (6-�O ft. + -I- -- ,-}-- 4- 4 -4- 4- 4- in.from ft.to ft. I I I I I (9) FOR REPLACEMENT WELLSgivedistance 'and direction from old well and plans for plugging -I- - -)- - -f- -f- - + - -1- - + __ -4- - 4. it: • The scale of the diagram is 2 inches=.1'mile V Each small square represents 40 acres. WATER EQUIVALENTS'MOLE`I Pounded Figures) An acre-foot covers 1 acre of land 1 foot deep L- 1 cubic foot per second'(cfs) ...449 gallons per minute (gpm) R1t A family of 5 will require approximately 1 acre-foot of water per year. 1 acre-foot...43,560'cubic feet...325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. (10) LAN■ 'N WHJJCH G- •UND W•TE- WILL :E US D• Owner(s): -- - • — - No.of acres: S0 Legal description/ekel Cm. Nw% NE % Sea./6 Ywp •21y (QNA 66 w-6fiw (11) DETAILED DESCRIPTION of the fuse of ground water`:�Househ Id use and domestic wells must indicate type of disposal system to be used. Avis a°% j d� A- W'Yl 9L"I •�7/e /&s20 /7Q4�'L. Sep Kite �- '.c&rA /P (8X/srs ) (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 4Y®-27e• • (13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS TRUE TO THE BEST OF H S KNOWLEDGE. o-t J c � • /6a#749-4.--1 NATURE OF APPLICANT(S) Use additional sheets of paper if more space is required. WRJ-26-J2- RECEIVED COLORADO DIVISION OF WATER RESOURCES, RECEIVED THISTORM MUST BE.SUBMITTED 300 Columbine Bldg:, 1845 Sherman St. WITHIN 80 DAYS 4.P-coMPLttlON , Denver, Colorado 80203 Am-178 OF THE WORK DESCRIBEp•HERE- "'TYPEOR PANTO BLACK WELL COMPLETION AND PUMP.INSTALLATION REPORT WATER RESOURCES PERMIT NUMBER 28.967-A4 STATE EN i OIfe CEO WELL OWNER J41#8 E. CZ Rh7WBWJBD 114 'h of the NI V.of Sec. 16 ADDRESS 1411+94 pf14LD CO. ;BD. 92 FT TufON T. N , ii 66 W 6 P.N DATE COMPLETED JULY 20 , 1948 HOLE DIAMETER WELL LOG 778 in. from 0 to 60 ft. d ' Water 558 in. from 60 to .35 ft. From To Type and Qplor of Material Loc. 0 1 in: from to ft. 14 'l5 Clay clay DRILLING METHOD ROTARY 45 104 8=, CASING RECORD: Plain Casing 104 115 "MS: 115 123 s alfic , Size_fig& kind s$erl from ___0___to 40 f 123 130 sand ! 130 135 aisle Size 4_& kind Ate l from 40 to 530 f 135 142 coal . g ,;. 142 250 shale and streakss of coal Size & kind from to f• 250 :337 shale 337 340 Coal Perforated casing 340 393 shale 393 397 coal Size -?If_& kind afoot,_from 530 to 655 f 397 430 shale 30 475 sand Size & kind from to f IIIIIrs,75 479 shale . 479 481 sand Size & kind from to f 481 509 shale 509 516 sand GROUTING RECORD 516 533 shale 533 534 land Material cement 534 545 shale 545 563 sand atreakes Intervals constant 563 586 sand good x 586 590 shale Placement Method pumps0 590 640 sand x 640 655 shale ., GRAVEL PACK: Size Interval TEST DATA 1-Date Tested MILT-20 . "<4 _ , 192E -,.: `- Static Water?Level.Prior to tgst - - 425- - f . P.. Type of Test Pump hails it,." . Length of Test 4hrsia1 Sustained Yield (Metered)' ` 15 • . TOTAL DEPTH 6558 Use additional pages necessary to complete lof).. Final Pumping Water Level 3400 PUMP IN,$T9LLATION REPO. t Pump Make • rt; a7 0.' w 4. nn * ` i Powered by '" r"' HP 4 Pump Serial No. i , .r• . .. WATER J Motor Serial No. la TABLE Date Installed i- ., t./. Pump Intake Depth £ "' Remarks ' ° Z • a N, WELL 'EST bATKWITH PERMAFENfPUMP 4 ra.w4 Date Tested J z T .'. ' -≥rowE Or i- d ,.' a DEPRESSION Static Water Level Pribr to Test t°. 0 t• : . Length`of Test"" Houts Alined yield (Metered) GPM a :• ' Pumping Water Level )` ' ` Remarks , . _ S :eRi5G .::6JJOC.s r �'ihl. CJ .. , . . ' , CONTRACTORS STATEMENT The undersigned,bei:ng,duly sworn upon oath, reposes and says that he is the contractor of the well or purtiOnstatlitiori described hereon; that he has read the statement made hereon; knows the content �., thetgof,and thatthe*n,jttrue of his own knowledge. :Signatutr' - License No. _ State of-Coloredo,ipotta y of SS Subscribed. vdistvorn to before me-this clay of , 19/21 ah My Cornblission expir s: •„. 19lir r Notary Put<itt€. FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM must be an original copy on both sides and signed. WHITE AND GREEN copies must be filed with the State Engineer.PINK COPY is for the Owner and YELLOW COPY is for the Driller. 1 wRJ 25-]5. • • RECEIVED COLORADO DIVISION OF WATER RESOURCES TYPE OR 818 Centennial Bldg., 1313 Sherman St. PRINT. IN BLACK INK. JUN15 E78 COPY OF ACCEPTED Denver, Colorado 80203 A T'EME NT MAILED _ WATER RES0URCESREr�uEsr. STATE OF COLORADO,_ '/ AFFIDAVIT gum mom COUNTY OF DE/yI! t7? SS au' STATEMENT OF BENEFICIAL USE OF GROUND WATER X AMENDMENT OF EXISTING RECORD ,r ee-pe.cc 4, ,o • 47%.3-eh&D. LATE REGISTRATION PERMIT NUMBER,/ CC LOCATION OF WELL Va THE AFFIANT(S) l e5 F• ex inWI a6 PG/vn,y • \A/r- L D whose mailing /J/(��[� // /' address is/7Y 7 (_ We/..t7C:0. / / 2 Z//_ ' N �i y.oI ,he Y//E' Yr, Section /4 City /r ^4,/,21-of- Cc O VO C.2 / ,wP. 2 , Rng. _6_4 le o n w, L P.M le�Anl Ism,' being duly sworn upon oath, deposes and says that he (they) is (are) the owner(s)�oof the well described hereon; the well is located as described above, at distances of .2 0 O feet from the /1Q ection line and �O© feet from the yy InoR N OR O J/sUTN, el S'7 'section line; water from this well was first applied to a beneficial use for the purpose(s) described herein on theg RG aA5T 01 tat" !� � day of NO V , 19,“, the maximum sustained.pumping rate of the well is :a gallons per minute, the pumping rate claimed hereby is 2 0 gallons per minute; the total depth of the well is 666-feet; the overage annual amount "'water to be diverted is / acre-feet; for which claim is hereby mode for DO7Y7 r 5 Yin / purpose(s); the legal description of the land on which the water from this well is used is _A75 /Kiteve of which acres are irrigated and which is illustrated on the map on the reverse side of this form; that this well was completed in compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with low; he (they) has (have) read the statements made hereon; knows the content thereof; and that the some are true of his (their) knowledge. C /JS LETS RE SIDE OF THIS FORM) Signature( �j�/C/� cf44 V 0 Subscribed nd s�. FOR OFFICE USE ONLY to before me onthis- -/'S' day of ' , 197t -.! Cowl Case No. My Commission expires: „1:24- -53— /97ic - — "E„) J Prior. Mo. Day Yr. I • v 1AeY voeLlc Di., Ct),. ACCEPTED FOR FILING BY T STATE ENGINEER OF COLORADO PURSUANT TO TH&F ILL0WING CONDITIONS: See.-- u. A. 'A. Well Use Dist. _ eosin Mon. Dis. _- • DATE STATE ENGINEER BY ...• . . • • . Well drilled by al , ye7` 00' 1 /145 Lic. No. 503 - r�• Permanent [ v0 3 Pump installed s by _ J� e Lic. No. Meter Serial No. — ❑ Flow Meter Date Installed Owner of land on which woter is being used 7G1ines E, (Li K Ail Yt bebi(C1 THE LOCATION OF THE WELL MUST BE SHOWN AND FOR LARGE CAPACITY IRRIGATION WELLS THE AREA ON WHICH THE WATER IS USED MUST BE SHADED OR CROSS-HATCHED ON THE DIAGRAM BELOW. This diagram represents nine (9) sections. Use the CENTER SQUARE (one section) to indicate the location of the well, if possible. I — 1 I T I 1 I — .f -- ± - 1+ — + + .- 1 I I I I I — + — + — + — + + + — NORTH SECtTION LIME { r x L NORTH + _ + tn- - z + - + - Si1 _ + Nif CA n J'a •.S t z ti-- I w I r '" - -I- rrn `Q W + + T i I SOUTH SECTIION.LIPIE - + + - + - + - ±f- - + - 1 1 1 - I I . THE SCALE OF THE DIAGRAM IS TWO INCHES E DUALS ONE-MIt E ' - 4 - + - + -- + - + y _:. '} - . - L I --1i Ni i l e WATER EQUIVALENTS TABLE (Rounded Figures) An acre-foot covers 1 acre of land 1 foot deep. 1 cubic foot per second (cfs) . . . 449 gallons per minute (gpm). 1 acre-foot . . . 43,560 cubic feet . . . 325,900 gallons. 1,000 gpm pumped continuously for one day produces 4.42 acre-feet. • 100 gpm pumped continuously for one year produces 160 acre-feet. (WHITE AND PINK COPY TO BE FILED WITH THE STATE ENGINEER PINK COPY WILL BE RETURNED TO OWNER) APR 4 1967 • ER nnnrar wxj-2s-e6 , FtS-}-t196.1 STATE OF COLORADO u` • 20 HI-45 DIVISION OF WATER RESOURCES allECE Index No. $1.Y� OFFICE OF THE STATE ENGINEER N0V 1 1966 WD /- a GR uNo WATER 6x...I se / MAP AND STATEMENT FOR WATER WELL FILINSKIN 15.O COLORADO Registered//-/56�6 WAiER.eEsoOacV ME PERMIT NUMBER •V i I L 7 SLATE ENGINEER Know all men by these presents; That the ,undersigned f_ . /4 , 1 k n claimant(s), whose address is fp / - 1 Sr , City ' P1(&(,_Oh A. o`" states: Claimant(s) is (are) the owner(s) of well No locates( as shown on the map below; 'the total number of acres of land owned by him (them) to be irrigated from this well is yeorlc was commenced on this well by actual construction TO day of -S'ciaf 19 the tested capacity.of said well is .2C9 (gpm) (efts), for which claim is hereby made for'] ,6,:..n,I;( „ purposes; that the average annual amount of water to be diverted is acre-ft. ; and that'the aforementioned statements,are made and this map and statement are filed in compliance with the law. State of.Colorado County ofL ) ss Claimant(s) ' Subscribed and sworn before me this day,of 19 My Commission expires Notary Public MAP THE WELL SHALL BE LOCATED WITH REFERENCE TO GOVERNMENT SURVEY CORNERS OR MONUMENTS, OR SECTION LINES BY DISTANCE AND BEARING. feet from . (North or South) section line " • feet from (East or West) section line IF WELL 'IS FOR IRRIGATION, THE AREA TO BE IRRIGATED MUST BE SHADED-OR .pROSS-- ,. 'LIATCHED. The square below will be used to indicate the location of the well and the irrigated land. 1 I I III e I I I I 1 I WELL LOCATION ' I I 1 I I . We ).. ) — C a- count — . —I---i +_—I___*- -I ' 1/ I I �1/4, sec. i I i ' `I. I I !r - - 1 - - I- - - r - - T - -I- - - r - -- T. :27 , R. L (/.1A) 6 P.M ^ I I I I II I I I Ground Water Basin I I t . I I I Water Management I` I I I I I District - - T - - 1 - - r = - - - - T --I - - r -' I I I I I I 1 I I 1 Domestic wells may be located by the —J. 1. 1 1,_....I._,..L__4._ 1 mi. following: LOT , BLOCK I I I I I I SUBDIVISIO I I I I I I I I I I I I _ I I I I. I 4C--. •CCEPTED FOR FILING IN THE OFFICE OF THE STATE ENGINEER OF COLORADO ON THIS DAY OF , 19 -Slate Engineer . r • LOG AND HISTORY • -•,• - • WELL LOG WELL DATA round Elevation Date Started C, 7n 1.3 C R L-J \ 1¶ G,4 CS' Type Drilling a T A JR. `l Date Completed/y0 VC-72v1 IBIZA 3 —1 9 Z.4. Water Hole Diameter: ' Fri' To Lfc�T -e o�'W,4torial Loc. Pert • - b in. from n ft. to y y ft. /, a di, -ye k 6-s-e e L.A v. lr in. from q y ft. to &SS ft. aa71 in. from ft. to ft. ' anli6 CASING RECORD y �� /2.A� / �tiLO w C� A 1/ Cemented from ��GKF�J 4 I)Ro irk 1 �- ,1 L b S I -A 1. L Plain Casing I 214.3 }'1'.3•)y RbG(,( Size 44,_, kind 5T.fdfrom_et__ft. to /4 ft. /2 iS /412L az a .E" SN4L L Size 'j , kind C711- from..L ft. to'j I ft. /1..13.i, 16d 9.t.. L k, S l-I Fa rgeom .. ajoy `i��,rE,E�P_-- G Y9 log 9.1,:, 153 a I b lit L c $ W k L E Size kinds. from*# ft. to fryi ft. .4/4 2$74 MID E611'41tRrzkf Perforated Casing 0 o A L Size S. , kinthaailrom.fla ft. to big g ft. .-147.14 - St Roc• N JC9 1fy1tski A z Arc 0 d A L Size_ , kind from ft. to ft. .299i Sled t3tae 5 4A-..A ie W•qy Size_, kind from__ft. to_ ft. > -t4 )V ,S—k s 0P Co iii. 351/a J1zi, Rib if $P A ( : TEST DATA Date Tested Whirl= Al RI:R 3- 15LL Si J7. 06 /ZC Type of Pump I�M/LA.-p 373 31y L34lerS /4ALf Length of Test PI,//rrs . �, Of Si Ail,/ en** J` •constant Yield AnTS!it 7I4AAr /401.1t Drawdown V e /7 I L I Fri_ 1r di 3,7 A/77 48A•4l S NA L j$ ' ' PUMP DATA (To be filled in) ../) 7 4'I>I 4 4.6Z5 a P SHALE-a iC k Type of Piimp 41017111#6./417A D +Cli//ICE •34 w0 $ #c ie Outlet Size ,f f vC t 5 Driven by- l (Y1 _d SS CYA AKA' SHA] p- Ike-7V 1 P Horsepower /4.- Use additional paper if necessary to complete DEPTH TO WATER log and attach. WELL DRILLERS STATEMENT TOTAL DEPTH 6 -SS r r State of Colorado • ) ss County of vV f 1 /) ) rin.4442.44 26O0-0-W being duly sworn, deposes and says: he is the driller of the above described well; he has read the above map and st4ement; kngvys tl)p content thereof, and the same is true of his own knowledge. !-v"f.w License-No. -CO 3 Subscribed and sworn to before me this day of , 19—. My Commission expires , 19___. _ Notary Public FORM TO BE MADE OUT IN QUADRUPLICATE:. .. ._ Original WHITE (both sides) &Triplicate GREEN Copy must be filed with the State Engineer within 30-days after well is completed. Duplicate PINK copy is for the Owner &YELLOW copy for the Driller. WHITE FORM MUST BE AN ORIGINAL COPY ON BOTH SIDES AND SIGNED. . ;... . . WR.', 5-Fri ' ( l� STATE OF COLORADO • inti L'a - A, PERMIT TO USE GROUND WATER APPLICATION FOR: ac A PERMIT TO CONSTRUCT A WELL SEP �Ii8 66 • / / OTHER �;o Application must be completed satisfactorily before acceptance Cet , PRINT OR TYPE ' LOCATION O?W C. APPLICANT .) O O P . 1 " A COUNTY Street Address / b }I .� ' J ;�r �_ 1 137�f:�4" sec.)L City & State Ft L L1.ft0t.f. , tbLA T. .D.1�/ , R. Cr 6' VI/ , gi P.M. Use of ground water Do/vtJ5'I/ci Ground Water Basin Owner of land on which well in t to Water Management is located (7, IL ro R b District Number of acres to be irrigated USE DIAGRAM-.ON- THE BACK OF THIS SHEET TO Legal description of L Z„ LOCATE. WELL. irrigated land Vy% i A 17- 9.J: ?2 ANWA, Other water 'rights on ,5-GG.I (rt.`C4' -R 6 this land. Driller 5/.rv-c.r__ fr-4 4( No. . d .3 Owner of irrigated Driller q land Address-W , .1-e3-4-1-.2-6), !Il v f h lV 5.d I Aquifer(s) ground water is to be obtained ' from 41 / ESTIMATED WELL DATA Sign ture of Appl ' ant t. quantity -of ground water to be claimed CONDITIONS OF APPROVAL Est. Max.; Yield S% (S GPM' or CFS Est, average annual amount to be used in acre-feet Storage capacity AF Anticipated start of-dril l ino4 3019 &&i(e. Hole Diameter: 'o in. from 0 ft. to 760 ft. in. from ft. to ft. Casing: Plain 4 in. from O ft. to IC() ft. in. from ft. to ft. Perf. j in. from t o ft. toObft. , in. from ' ft. to ft. PUMP DATA: Outlet !/ . Type L1 . HP Size This application approved This application approved PERMIT NUMBER 28967 CONDITIONAL PERMIT NO.. DATE ISSUEDof SEP 28 1966 (Permit good for for one. (i1,YRar,after date an DATE ISSUED • State Erfpe 1(Je1e Chairman Ground Water Gommission r by by ' (OVER) n,: THE LOCATION OF 'THE PROPOSED WELL SHALL BE SHOWN ON THE DIAGRAM BELOW. THE LOCATION • WILL BE 1NDltktED BY THE DISTANCES FROM THE SECTION 'LINES; OR THE DISTANCE AND BEAR- . • ING FROt1Movrn HgNT SURVEY CORNERS OR MONUMENTS. IF WELL IS FOR"IRRIGATION, THE AREA TO BE IRRIGATED MUST BE SHADED OR CROSS-HATCHED. Domestic wells may be located by the following: Lot r A5hock .. ' , `\\ : Street Address "or . City Subdivision • The diagram represents nine (9) sections. Use the center square (section) to indicate the location of the well . H , • • Ic • • • THE SCALE OF THE DIAGRAM IS TWO INCHES EQUALS ONE-MILE I . • • DATE Noel 4 9 us RECEIVED FROM ` " '.' i �� - up ADDRESS I'-, I, o .., ce DOLLARS $ - - OF0R RENT - - ❑FOR ' J�41 , - - air -- 11( ' 1 am ACCOUNT - HOW PAID AMT OF -__CASH-. -ACCOUNT •r AMT PAID CHECK-- BALANCE MONEY- BY - - DUE .-'ORDER - ��'": � 1a,r4 c 4,, #�' ' ,'%R' wn, - soh Yidle1`T { 0,,,+',-z^e zs'. 2 fc �a* a h4 i v5 k V 'fl b+ to • ✓ �*' ! . i L•v '�s...xYA e A°.. °Fsw' x`L{.4u a 4f'* *+ ^. » 'P' ,a `s' ° towik lt �,� 44,7ACCOUNT HOW PAID +i�ak,. � *'" " k 444 h AMT.OF ,QTR'" 'R`s°d,� ". '" p4 ; ,A �, ' ACCOUNT ' .. y ady." yY,yn w, AMT.PAID CHECK �„ Ky. ,. h •�a *°' lz- ,€ BALANCE MONEY " Ati1 f "�>4,1‘ % By� '' '�3 DUE.. . . - ORDER FZTq^M+i. mum4�tagibi ...V-L. ' m a- -C L' Pb T K''4' s✓ 'wfi '+ '° ^aLu a 't s. ' rp t K.g0 k yK1 a' .nn y aten8 1 wr >y p&i s Yw r Y ^." - �. ° €.71 ,jj '�` Fta � :.�� *>^ e'er •y . i• Y �4 `Y +`a` Y v, .ems. ` . *"`,,, o-r.cam:.^'x.. • • Wa ,« ,. ACCOUNT HOW PAID :: ,;, • AMT.OF '` ," Pga` : ACCOUNT +§.` "`s AMT.PAID CHECK { ¢ i� '°.,- BALANCE M u�� DUE ORDER Hello