Free GWS-52, NONTRIBUTARY GROUND WATER DEEMED CONSENT CLAIM - Colorado

FORM NO. GWS-52 (03/03)

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

NONTRIBUTARY GROUND WATER DEEMED CONSENT CLAIM
(FOR AREAS WITHIN A DESIGNATED GROUND WATER BASIN)

________________________________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 Rule 5.3.10 of the Designated Basin Rules, 2 CCR 410-1. Please check one of the following: ______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, in accordance with Rule 5.3.10 of the Designated Basin Rules, is attached. OR ______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, in accordance with Rule 5.3.10 of the Designated Basin Rules, has been previously filed with the Ground Water Commission. I (we) verify that this map and information thereon is still true and correct.

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: The consent claim must be submitted with an application for determination of water right in all cases where the applicant is a municipal or quasi-municipal water supplier and believes or claims that water to be withdrawn is ground water from the Dawson, Denver, Arapahoe or Laramie-Fox Hills aquifers and the applicant is claiming consent of the overlying landowners in accordance with Rule 5.3.10 of the Designated Basin Rules. Please type or print neatly in black ink. This form may be reproduced by photocopy or word processing means.
Colorado Ground Water Commission, 1313 Sherman St Rm 818 Denver CO 80203 (303) 866-3581