Free Microsoft Word - 03ACNSNT.DOC - Colorado

GWS-3A (Rev. Oct. 2006)

STATE OF COLORADO OFFICE OF THE STATE ENGINEER DIVISION OF WATER RESOURCES

NONTRIBUTARY GROUND WATER CONSENT CLAIM

_______________________________________ AQUIFER

I (We)_________________________________________________________________ (Name) claim and say that I (we) have the consent of the owners of _________acres of overlying land to withdraw ground water from the aquifer indicated above; and that such claim is made in accordance with the Statute indicated below. ______ C.R.S. 37-90-137(4)(b)(II)(A) ______ C.R.S. 37-90-137(4)(b)(II)(B) ______ C.R.S. 37-90-137(4)(b)(II)(C) The names of the landowners whose consent is claimed pursuant to C.R.S. 37-90137(4)(b)(II)(A) are as follows and their landownership statements and other documents are attached. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 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) own knowledge.

__________________________________________________ (Signature)

______________ (Date)

___________________________________________________ _____________ (Signature) (Date) ............................................................................................................................................ INSTRUCTIONS: Please type or print neatly in black ink. This form may be reproduced by photocopy or word processing means. See additional instructions on back. 1313 SHERMAN ST RM 818 DENVER CO 80203 (303)866-3581

9/26/96 CONSENT CLAIM INSTRUCTIONS

The consent claim must be submitted with the well permit application in all cases where the well permit applicant believes or claims that water to be withdrawn is nontributary ground water or any ground water from the Dawson, Denver, Arapahoe or Laramie-Fox Hills aquifers.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 applicant for the well permit is claiming the consent of overlying landowners in accordance with the provisions of Sections 37-90-137(4)(b)(II)(A), (B) or (C), C.R.S. Rule No. 5.C.(2) of the Statewide Nontributary Ground Water Rules requires the following: 2) If the applicant claims consent of the owner(s) of the overlying land, he shall submit, with his permit application, a statement on a form supplied by the State engineer, stating whether consent is claimed pursuant to paragraphs a), b), or c) following: a) If the applicant relies on Section 37-90-137(4)(b)(II)(A), C.R.S., a written consent from the well owner to the applicant and evidence of the ownership of land by a statement, as deed or other document recorded in the county or counties in which the land is located and which includes a legal description of the land for which consent has been given and the aquifers for which consent has been given. b) If the applicant relies on Section 37-90-137(4)(b)(II)(B), C.R.S., a certified copy of the ordinance or resolution and a copy of the water court application certified by the water court. c) If the applicant relies on Section 37-90-137(4)(b)(II)(C), C.R.S., a certified copy of the ordinance or resolution and a certified copy of a detailed map showing the land area as to which consent is deemed to have been given, as required by Section 37-90-137(8), C.R.S. If such a map has been previously filed with the State Engineer, the applicant need not file another map, but shall reference that map and certify that the information thereon is still true and correct.

Legal Description 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.