District Court, Water Division ___________________, Colorado Court Address: ________________________________________________________ CONCERNING THE APPLICATION FOR WATER RIGHTS OF Applicant: In the ____________________________River or its Tributaries In ________________________________________ COUNTY Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number: Phone Number: FAX Number: E-mail: Atty. Reg. #: Division: Courtroom: APPLICATION FOR CONDITIONAL ABSOLUTE UNDERGROUND WATER RIGHT It is the applicant's responsibility to provide the location for each structure in this application. For structures that are already decreed, use the location from the most recent decree that adjudicated the location. UTM 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. If Applicant is applying for an underground water right for an exempt well pursuant to § 37-92-602(4), C.R.S. or an underground water right in the Denver Basin Aquifers, Applicant should use Form JDF 298Wb or JDF 308W, respectively. 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 Telephone Number 2. Name(s) of well(s) and permit, registration, or denial number(s). Attach copies of well permit, pump installation report, well construction and test report and statement of beneficial use (if available). (If permit applied for, but not acted upon, give date of permit application.) Name of Well Permit, Registration, or Denial Number If Permit is pending, check box below and provide date of application. Date: Date: JDF 298W(a) R5-15 APPLICATION FOR UNDERGROUND WATER RIGHT AND CERTIFICATE OF NOTICE © 2013, 2014, 2015 Colorado Judicial Department for use in the Courts of Colorado Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 3. Legal description of well: Location 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 topographic map; or other source. In areas having generally recognized street addresses, also include street address, and if applicable, the lot, block, and subdivision. Attach a legible 8 ½ x 11 inch map to this application illustrating location of the well. UTM coordinates Easting ___________________ Northing _____________________ Zone 12 Zone 13 Subdivision: Street Address:_______________________________________________________________________ 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): Include perpendicular distances from section lines, and indicate ¼ ¼, section number, township, range, meridian and county; mark the location of the well on a USGS topographic map and attach to this application a legible 8 ½ 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 street addresses, also include street address, and if applicable, the lot, block, and subdivision. Legal Description: County Section Township _______ N or S Range _______ E or W Principal Meridian ______1/4 of the _____1/4 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 4. A. Source of water (for example, groundwater tributary to the South Platte): B. Depth of well, if completed: JDF 298W(a) R5-15 APPLICATION FOR UNDERGROUND WATER RIGHT AND CERTIFICATE OF NOTICE © 2013, 2014, 2015 Colorado Judicial Department for use in the Courts of Colorado Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 5. A. Date of appropriation: ____ B. How appropriation was initiated: C. Date water applied to beneficial use (for example, the date that the applicant first operated the well for its intended use): 6. Does the well withdraw tributary groundwater: Yes Conditional _____________ ( gpm cfs) No If YES fill out A and B: A. Amount claimed in gallons per minute (gpm) or cubic feet per second (cfs): Absolute _______________( gpm cfs) B. Amount claimed in acre feet annually (one acre foot is the amount of water required to cover an area of one acre to a depth of one foot, and is equal to approximately 325,900 gallons) Conditional _____________ (acre feet) Absolute _______________(acre feet) If claiming an absolute water right, application shall include supporting evidence that applicant diverted water in-priority and applied such water to the beneficial uses claimed in the amounts claimed. 7. Does the well withdraw nontributary groundwater:Yes A. Name of aquifer into which the well is drilled, if known: B. Amount claimed in gpm or cfs: Conditional _____________ ( gpm cfs) Absolute _______________( gpm cfs) No If YES fill out A, B, and C: C. Amount claimed in acre feet annually (one acre foot is the amount of water required to cover an area of one acre to a depth of one foot, and is equal to approximately 325,900 gallons) Conditional _____________ (acre feet) Absolute _______________(acre feet) If claiming an absolute water right, application shall include supporting evidence that applicant diverted water and applied such water to the beneficial uses claimed in the amounts claimed. 8. Does the well operate pursuant to a decreed plan for augmentation? Yes A. Case number of pla