Free DBB-016, Application to Reduce Permitted Acres and Authorized Annual Appropriation - Colorado

DBB-016 (6/2006) APPLICATION TO REDUCE PERMITTED ACRES AND AUTHORIZED ANNUAL APPROPRIATION 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 __________, Range _______West of the 6th P.M., and the owner of the land on which this well is located. As owner of this well, I hereby request to decrease the number of permitted irrigated acres and: the annual appropriation so that it amounts to no more than 3.5 acre-ft/acre (for the Southern High Plains [SHP]).



the annual appropriation so that it amounts to no more than 2.5 acre-ft/acre (for
Designated Basins excluding the SHP). The permitted irrigated acres to remain are as follows: Number of Acres: ___________ Legal Description of Remaining Permitted Irrigated Acres:________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Remaining Permitted Annual Appropriation: ____________ acre-ft Enclosed herewith is the nonrefundable application fee of $100. I understand that this is a permanent change of water right for this well. I hereby affirm that I have read and understand the above statement and the information I have provided is true and correct. Signed and dated this ____________ day of __________________________, 20____________. Signature of Applicant: __________________________________________________________ Applicant's Name: Address: City, State & Zip Telephone No. Div. Co. __________________________________________________________
(Please Print)

__________________________________________________________ __________________________________________________________ __________________________________________________________ WD FOR OFFICE USE ONLY Basin MD Use Receipt No.______

DBB-016 (6/2006)