Free DBB-007, Application for Change of Description of Acres - Colorado

DBB-007 (6/2006)

APPLICATION FOR CHANGE OF DESCRIPTION OF ACRES COLORADO GROUND WATER COMMISSION Room 818 Centennial Building, 1313 Sherman Street Denver, CO 80203

Application must be complete where applicable. Type or print in BLACK INK. No overstrikes or erasures unless initialed.

NOTE: This application can only be used for wells located within a Designated Ground Water Basin. I am the owner of the well with Permit No._______________ located in the _________1/4 of the ________1/4 of Section ________, Township ___________ North/South, Range __________ West of the 6th P.M. The well is permitted to irrigate a total of _____________ acres. I hereby request to change the description of acres to be irrigated by this well to read as follows: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________. I understand that I am not allowed to irrigate any unpermitted lands without first obtaining such a permit from the Commission. Enclosed herewith is the nonrefundable application fee of $100. I understand that this request will be published in the local newspaper(s) as may be required by law and that I will pay the actual publication cost to the Commission when the same is billed to me. I have read the statements made herein and know the contents thereof, and that they are true to my knowledge. Signed and dated this ____________ day of _______________________________, 20____________.

Signature of Applicant: ________________________________________________________________ Applicant's Name: Address: City, State & Zip: Telephone No.: ________________________________________________________________
(Please Print)

________________________________________________________________ ________________________________________________________________ ________________________________________________________________

Div.

Co.

WD

FOR OFFICE USE ONLY Basin MD Use

Receipt No.______

APPLICATION FOR CHANGE OF DESCRIPTION OF ACRES COLORADO GROUND WATER COMMISSION

Diagram of Irrigated Acres and Well Locations. This diagram must be completed. Label all wells with permit numbers.

1 mile, 5280 feet

North Section Line

West Section Line

East Section Line

N
South Section Line

The scale of this diagram is 2 inches = 1 mile. Each small square represents 40 acres. Incomplete applications will be returned to applicant 2