Free GWS-38 - Colorado

GWS-38

600 FOOT WELL SPACING STATEMENT

I (we) ____________________________________________________ state as follows:

1.

I (we) own real property described as ________________________________ in the ____ ¼ of the ____ ¼, Section ____, Township _____, Range ________, ________ P.M., __________________ County, Colorado. We own the right and easement to the following well: Actual Distance from N/S Sec. Line _________ ft. Actual Distance from E/W Sec. Line _________ ft.

Permit # ___________ 2.

1/4 ___

1/4 ___

Sec. ___

Twp. _____

Rng. _____

I (we) have been apprised that _____________________________________, the present owners of a parcel of land in the ______ ¼ of the _____ ¼, Section ____, Township _____, Range ________, ________ P.M., desire to drill a new well or extend the use of an existing well. I (we) also understand that the purpose of such well is set forth in the well permit application, and that I (we) have reviewed the application that was submitted to the State Engineer and receipted by him under receipt no. ___________________.

3.

The proposed location for the subject well will be 600 feet or less from my (our) well.

4.

By this statement I (we) am (are) specifically waiving any objection to the issuance of a well permit for the subject well, as set forth in the referenced application, and would request that permit issuance not be postponed or denied because of any concerns by the Division or others that the proposed well will materially affect my (our) well or water right. I (we) am (are) also specifically waiving my (our) right I (we) may have to participate in a hearing before the State Engineer pursuant to Section 37-90-137(2), C.R.S.

Dated this ________ day of ____________________, _______

_________________________________________

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