Free GWS-01, NONTRIBUTARY GROUND WATER LANDOWNERSHIP STATEMENT - Colorado

GWS 1 03/2005 STATE OF COLORADO OFFICE OF THE STATE ENGINEER DIVISION OF WATER RESOURCES 1313 Sherman St. Room 821 Denver, CO 80203 (303) 866-3581 Fax (303) 866-3589 NONTRIBUTARY GROUND WATER LANDOWNERSHIP STATEMENT I (We) _________________________________________________________________
(Name(s))

claim and say that I (we) am (are) the owner(s) of the following described property consisting of ____________ acres in the County of _____________________________, State of Colorado: (Insert the property legal description)

and, that the ground water sought to be withdrawn from the _______________________________ aquifer underlying the above-described land has not been conveyed or reserved to another, nor has consent been given to its withdrawal by another. Further, I (we) claim and say that I (we) have read the statements made herein; know the contents hereof; and that the same are true to my (our) knowledge.

_________________________________________________ Signature Date _________________________________________________ Signature Date ................................................................................................................................. INSTRUCTIONS: Please type or print neatly in black or blue ink. This form may be reproduced by photocopy or word processing means. See additional information on the reverse side.

LANDOWNERSHIP STATEMENT INSTRUCTIONS

The landownership statement must be submitted with well permit applications or applications for determinations of water rights in all cases where the well permit applicant believes or claims that water to be withdrawn is nontributary ground water or any ground water from the Dawson, Denver, Arapahoe or Laramie-Fox Hills aquifers. The statement must be signed by the landowner(s).

The legal description and the number of acres of overlying land must be indicated. In areas of the state that are not surveyed, the State Engineer will accept an alternate description of the location of the overlying land sufficient to identify and locate the land. For legal descriptions of irregularly shaped parcels (where the boundaries do not follow or parallel section lines) or where there are exclusions of land within the total parcel, the applicant must submit a map having a scale of 1:24,000 or larger (e.g., 1:10,000) which accurately depicts the overlying land.

If the legal description is too lengthy for the space provided on the statement, please indicate "See attached legal description" in the space provided on the statement and attach the complete legal description. The legal descriptions and maps provided must be complete and legible.

The aquifer from which ground water is to be withdrawn must be indicated on the space provided. Where applications for more than one aquifer are submitted at one time, the applicant shall provide a separate statement for each aquifer. Production from a well is limited to one aquifer only.