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COLORADO DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN ST, RM 818, DENVER, CO 80203
phone ­ info: (303) 866-3587 main: (303) 866-3581 fax: (303) 866-3589 http://www.water.state.co.us

Office Use Only

Form GWS-45 (07/2009)

GENERAL PURPOSE Water Well Permit Application
Review instructions on reverse side prior to completing form. The form must be completed in black or blue ink or typed.

1. Applicant Information
Name of applicant

6. Use Of Well (check applicable boxes)
Attach a detailed description of uses applied for. Industrial Dewatering System Geothermal ( production or reinjection) Municipal Irrigation
State Zip code

Mailing address

City

Commercial
Maximum pumping rate

Other (describe):

Telephone #

E-mail (Optional)

7. Well Data (proposed)
Annual amount to be withdrawn

(

)

gpm
Total depth Aquifer

2. Type Of Application (check applicable boxes)
Construct new well Replace existing well Use existing well Change or increase use Change source (aquifer) Reapplication (expired permit) COGCC well Other:
Water Court case # Well name or #

acre-feet

feet

8. Land On Which Ground Water Will Be Used
Legal Description (may be provided as an attachment):

3. Refer To (if applicable)
Well permit # Designated Basin Determination #

4. Location Of Proposed Well (Important! See Instructions)
County 1/4 of the Section Township N or S Range E or W 1/4 Principal Meridian

(If used for crop irrigation, attach a scaled map that shows irrigated area.)

A. C.

# Acres

B.

Owner

List any other wells or water rights used on this land:

Distance of well from section lines (section lines are typically not property lines) Ft. from

N feet

S

Ft. from

E

W

For replacement wells only ­ distance and direction from old well to new well

direction
Check if well address is same as in Item 1.

9. Proposed Well Driller License #(optional): 10. Signature Of Applicant(s) Or Authorized Agent
The making of false statements herein constitutes perjury in the second degree, which is punishable as a class 1 misdemeanor pursuant to C.R.S. 24-4-104 (13)(a). I have read the statements herein, know the contents thereof and state that they are true to my knowledge.
Sign here (Must be original signature) Date

Well location address (Include City, State, Zip)

Optional: GPS well location information in UTM format You must check GPS unit for required settings as follows:
Format must be UTM Zone 12 or Zone 13 Print name & title

Easting Northing
YES

Units must be Meters Datum must be NAD83 Unit must be set to true north Was GPS unit checked for above?

Office Use Only
USGS map name DWR map no. Surface elev.

Remember to set Datum to NAD83

5. Parcel On Which Well Will Be Located
(YOU MUST ATTACH A CURRENT DEED FOR THE SUBJECT PARCEL) A. Legal Description (may be provided as an attachment):

Receipt area only

B. D.

# of acres in parcel

C.

Owner

AQUAMAP WE

Will this be the only well on this parcel?

YES

NO (if no ­ list other wells)

WR CWCB

E.

State Parcel ID# (optional):

TOPO MYLAR SB5

DIV _____ WD _____ BA _____ MD _____

COLORADO DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES

GWS-45 GENINST (07/2009)

GENERAL PURPOSE WELL PERMIT APPLICATION INSTRUCTIONS
Applications must be typewritten or printed in BLACK or BLUE INK. ALL ITEMS in the application must be completed. Incomplete applications may be returned to the applicant for more information. Applications are evaluated in chronological order. Please allow approximately six weeks for processing. This form may be reproduced by photocopying or computer generation. Reproductions must retain margins and print quality of the original form. FEES: This application must be submitted with a $100 filing fee. Acceptable forms of payment are check or money order, payable to the Colorado Division of Water Resources, and Visa, MasterCard or Discover (card number and expiration date must be provided on a separate attachment). Fees are nonrefundable. USES: This form (GWS-45) is to be used to apply for commercial, industrial, municipal, irrigation, feedlot, geothermal, recovery wells, and other uses not otherwise noted in the following list: RESIDENTIAL use wells ­ Use of form GWS-44 is required LIVESTOCK watering on a farm, ranch, range or pasture (not feedlots) ­ Use form GWS-44 MONITORING/OBSERVATION wells ­ Use form GWS-46 GRAVEL PITS ­ Use form GWS-27 REGISTRATION of an existing well ­ Use form GWS-12 (must have been in use prior to May 8, 1972) GEOEXCHANGE SYSTEM LOOP FIELDS ­ Use form GWS-72 REPLACEMENTS OF WELLS FOR THE ABOVE USES ITEM INSTRUCTIONS: (numbers correspond with those on the front of this form) 1. The applicant is the entity for whom the permit is to be issued. Provide the applicant name and the mailing address where all correspondence will be sent. Check all boxes that apply. Complete all boxes that apply. If the permit is to be issued pursuant to a water court decree or a Designated Basin determination of water right, the case number or determination number must be indicated. If applying to replace or change the use of an existing well, the permit number of the existing well must be indicated. The county, ¼ of the ¼ section designation (example: NE ¼ of the SE ¼), section #, township, range, principal meridian, and distances from section lines for the proposed well must be provided. (An option to providing distances from section lines and the ¼ of the ¼ section designation is to provide an accurate GPS location (UTM coordinates). If providing a GPS location, the required GPS unit settings must be as indicated on this form. Colorado contains two UTM zones (12 & 13). Zone 13 covers most of Colorado. The boundary between th Zone 12 and Zone 13 is the 108 Meridian (longitude). West th th of the 108 Meridian is UTM Zone 12 and east of the 108 th Meridian is UTM Zone 13. The 108 Meridian is approximately 57 miles east of the Colorado-Utah state line. On most GPS units, the UTM zone is given as part of the Easting measurement, e.g. 12T0123456. Check the appropriate box for the zone. Exception to above: If you use this form to apply for a permit to construct a well for commercial exempt/small capacity use pursuant to CRS 37-92-602 or 37-90-105, you must provide the following minimum information: (a) the county, section #, township, range and principal meridian; (b) the subdivision lot, block & filing/unit designations as applicable if in a subdivision. You do not need to provide distances from section lines or a GPS location (UTM coordinates). "Commercial exempt/small capacity" is NOT the same as "commercial" and is a more 5. restrictive use category, generally limiting use of the well to drinking and sanitary purposes only. If you are applying for commercial use and are uncertain as to whether that use is "exempt/small capacity", please contact a Division of Water Resources office (see contact info below) prior to submitting the application to avoid delays in the evaluation process. Provide the property address of the well location if one exists. If it is the same as the mailing address, check the box next to the well location address. You must attach a current deed for the subject parcel. Complete all boxes and provide a complete legal description of the parcel of land on which the well will be located (Box 5E is optional). Check all boxes that apply and attach a detailed description of the uses applied for. (Important!: For commercial exempt/small capacity use you MUST attach a completed worksheet form GWS-57 if the well location is outside a Designated Basin and form GWS-61 if the location is inside a Designated Basin.) Complete all boxes. Complete all boxes and provide a legal description of the land areas on which ground water from the proposed well will be used. If agricultural irrigation is a proposed use, provide a map of the land area with proposed irrigated areas accurately drawn, including section numbers and section lines. A list of all other wells or water rights used on the described land must be provided. The well must be constructed by a Colorado licensed well driller, an authorized individual, or special licensed contractor, in accordance with the Water Well Construction Rules, 2 CCR 402-2, or under the "private driller" provision as defined in CRS 37-91-102(12). A listing of licensed well drillers/pump installers is available at http://www.state.co.us/boe/contractors.asp.

6.

7. 8.

9.

2. 3.

4.

10. An ORIGINAL signature must be on the application. The individual signing the application must be the applicant or an officer of the corporation/company/agency identified as the applicant. An authorized agent may sign the application, if a letter signed by the applicant is submitted with the application authorizing that agent to sign on the applicant's behalf. IF YOU HAVE ANY QUESTIONS regarding any item on the application form, please call the Division of Water Resources Ground Water Information Desk (303-866-3587), or the nearest Division of Water Resources Field Office located in Greeley (970-352-8712), Pueblo (719-542-3368), Alamosa (719-589-6683), Montrose (970249-6622), Glenwood Springs (970-945-5665), Steamboat Springs (970-879-0272), or Durango (970-247-1845), or refer to the CDWR web site at http://www.water.state.co.us for general information, additional forms, and access to state rules or statutes.