JDF 299W R 8/17 APPLICATION FOR CHANGE OF WATER RIGHT AND CERTIFICATE OF NOTICE Page 1 of 7 District Court, Water Division , Colorado Court Address : CONCERNING THE APPLICATION FOR WATER RIGHTS OF Applicant: In the River or its Tributaries In COUNTY COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division: Courtroom: APPLICATION FOR CHANGE OF WATER RIGHT A change of water right means a change in the type, place, or time of use, a change in the point of diversion, a change from a fixed point of diversion to alternate or supplemental points of diversion, a change from alternate or supplemental points of diversion to a fixed point of diversion, a change in the means of diversion, a change in the place of storage, a change from direct application to storage and subsequent application, a change from storage and subsequent application to direct application, a change from a fixed place of storage to alternate places of storage, a change from alternate places of storage to a fixed place of storage, or any combination of such changes. [ abso lute ] water rights. 247 37 - 92 - 103 (5), C .R.S. An application for approval of a change of water right shall include a complete statement of such change, including a description of all water rights to be established or changed, a map showing the approximate l ocation of historical use of the rights, and records or summaries of records of actual diversions of each right the applicant intends to rely on to the extent such records exist. 247 37 - 92 - 302(2)(a), C .R.S. If an applicant desires to apply for a simple change in surface point of diversion pursuant to 247 37 - 92 - 305(3.5), C.R.S., please use form JDF 241 W. If an applicant desires to apply for a correction for an established bu t erroneously described point of diversion pursuant to 247 37 - 92 - 305(3.6), C.R.S., pl ease use form JDF 240 W. the location for each undecreed structure in this application. For structures that are already decreed, use the location from the most recent decree that adjudicated the location . U TM coordinates ( for example from a GPS device ), or measured distances in the field from known section lines are acceptable. The Division Engineer, the Water Referee, or the Water Judge, may order the applicant to confirm the location of any structure with UTM coordinates, a survey, or other method. 1. Name, mailing address , email address and telephone number of applicant(s) (if there are multiple applicants, and the space provided is not adequate to list all of the applicants, the names, addresses, telephone numbers and available email addresses must be provided as an attachment) : Name of Applicant Mailing Address Email address Telep hone Number 2. Decreed water right for which change is sought: American LegalNet, Inc. www.FormsWorkFlow.com JDF 299W R 8/17 APPLICATION FOR CHANGE OF WATER RIGHT AND CERTIFICATE OF NOTICE Page 2 of 7 A. Name of structure: B. Date of original and all relevant subsequent decrees: Case No: Court: C. Legal description of structure as described in most recent decree that adjudicated the location : Provide a verbatim legal description from the most recent decree that adjudicated t he location . M ark the location of the structure on a USGS topographic map and attach to this application a legible 8 275 x 11 inch copy of th e applicable portion of the map . D. Decreed s ource of water : E. Appropriation Date: F. Total a mount decreed to structure in gallons per minute (gpm) or cubic feet per second (cfs) : Conditional Absolute G. Decreed use or uses: H. Amount of water that a pplicant inten ds to change: Conditional Absolute 3. Detailed description of p roposed change: A. C omplete statement of change, including a description of all water rights to be changed , a USGS topographic map showing the approximate location of historical use of the rights and proposed place of use , and records or summaries of records of actual diversions of each right the applicant intends to rely on to the extent such records exist . In addition, the applicant may submit a report by an engineer that includes this information. Please be aware that early in the proceedings, the applicant will be required to supply detailed information, such as the historical consumptive use on a monthly basis of the water rights the applica nt propose s to change and an analysis of historical return flow patterns . The applicant is encouraged to provide such information with this application. B. If applicant is correcting the location of a well in an existing decree where the actual location of the well is more than 2 00 feet from the decreed location, or drilling a replacement well more than 200 feet from the American LegalNet, Inc. www.FormsWorkFlow.com JDF 299W R 8/17 APPLICATION FOR CHANGE OF WATER RIGHT AND CERTIFICATE OF NOTICE Page 3 of 7 decreed location, provide le gal description of decreed location in paragraph 2.C . above. Provide a ctual or new location of well: L ocation information in UTM format (Preferred): UTM Zone must be 12 or 13; Units must be Meters; Datum must be NAD83 ; and Units must be set to true North . Include the source of the UTM coordinates , for example : GPS device , a GIS system such as DWR AquaMap or CDSS MapViewer; scaled from USGS topo graphic map ; or other source. In areas having generally recognized street addresses, also include street address, and if applicable, the lot, block, and subdivision . A ttach a legible 8 275 x 11 inch map to this application illustrating location of the structure . UTM coordinates East ing North ing Zone 12 Zone 13 Street Address: Subdivision: Lot Block Source of UTMs ( for example , hand - held Garmin GPS): Accuracy of location displayed on GPS device ( for example, accurate to within 200 feet): Legal Description Using the Public Land Survey System (PLSS) ( Optional ; Please include both UTM and PLSS descriptions if known ) : I nclude perpendicular distances from section lines, and indicate 274 274, section number, township, range , meridian and county ; mark the location of the structure on a USGS topographic map and attach to this application a legible 8 275 x 11 inch copy of the applicable portion of the map. In areas where section lines have not been established, a bearing and distance to an established government monument is acceptable. Include the source of PLSS information , for example: GIS system such as DWR AquaMap or CDSS MapViewer; field survey ; scaled from a USGS topographic map; or other source. In areas having generally recognized s treet addresses, also include street address, and if applicable, the lot, block, and subdivision . Legal Description: County 1/4 of the 1/4 Section Township N or S Range E or W Principal Meridian Distance from section lines (not from property lines) Feet from N S and Feet from E W Source of PLSS information: Street Address: Subdivision: Lot Block American LegalNet, Inc. www.FormsWorkFlow.com JDF 299W R 8/17 APPLICATION FOR CHANGE OF WATER RIGHT AND CERTIFICATE OF NOTICE Page 4 of 7 C. If a change in point of diversion, provide legal descriptions of decreed location and actual or new location of structure : L ocation information in UTM format (Preferred): UTM Zone must be 12 or 13; Units must be Meters; Datum must be NAD83 ; and Units must be set to true North. Include the source of the UTM coordinates , for example : GPS device , a GIS system such as DWR AquaMap or CDSS MapViewer; scaled from USGS topo graphic map ; or other source. In areas having generally recognized street addresses, also include street address, and if applicable, the lot, block, and subdivision . A ttach a legible 8 275 x 11 inch map to this application illustrating location of the structure . UTM coordinates Northing Easting Zone 12 Zone 13 Street Address: Subdivision: Lot Block Source of UTMs ( for example , hand - held Garmin GPS): Accuracy of location displayed on GPS device ( for example, accurate to within 200 feet): Legal Description Using the Public Land Survey System (PLSS) (Optional , Please include both UTM and PLSS descriptions if known ) : I nclude perpendicular