Free DBB-010, Application for Alternate Points of Diversion - Colorado

DBB-010 (8/2008)

APPLICATION FOR ALTERNATE POINTS OF DIVERSION COLORADO GROUND WATER COMMISSION Room 818 Centennial Building, 1313 Sherman Street Denver, CO 80203

NOTE:

This application can only be used for wells located within a Designated Ground Water Basin. Additional information, including estimates of historic withdrawal for the wells, will be required for areas where water is not available for new appropriations.

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

I am the owner of the wells with permit numbers as referenced below and I hereby apply to obtain approval to use the subject wells as alternate points of diversion for each other. I understand that I am not allowed to use these wells as such without first obtaining approval from the Commission.
Permitted Number of Acres __________ Permitted Average Annual Appropriation (acre-feet) ______________

Permit No. _____________

Well Location _________________________________________________ 1/4 of the __________1/4, Sec______, T_________N/S, R________W 1/4 of the __________1/4, Sec______, T_________N/S, R________W 1/4 of the __________1/4, Sec______, T_________N/S, R________W 1/4 of the __________1/4, Sec______, T_________N/S, R________W 1/4 of the __________1/4, Sec______, T_________N/S, R________W 1/4 of the __________1/4, Sec______, T_________N/S, R________W

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NOTE:

COMPLETE DIAGRAM ON BACK OF APPLICATION

Total

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The land to be irrigated by these wells, without duplication of acres, totals

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acres and is

described as follows:_______________________________________________________________________________________________________________________________________________.
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Enclosed herewith is the nonrefundable application fee of $_______________ (The fee required is $100 per permit involved.) 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: ________________________________________________________________
(Please Print)

________________________________________________________________ ________________________________________________________________ FOR OFFICE USE ONLY Basin MD Use

Div.

Co.

WD

Receipt No.______

Telephone No.:

________________________________________________________________ APPLICATION FOR ALTERNATE POINTS OF DIVERSION 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