COLORADO GROUND WATER COMMISSION DIVISION OF WATER RESOURCES DEPARTMENT OF NATURAL RESOURCES 1313 Sherman St, Room 818, Denver, CO 80203
APPLICATION TO CHANGE A DETERMINATION OF WATER RIGHT PURSUANT TO SECTION 37-90-111(1)(g), C.R.S.
NOTE: This application can only be used to apply to change the conditions of a Determination of Water Right approved by the Ground Water Commission pursuant to Section 37-90-107(7), C.R.S, for the Dawson, Denver, Arapahoe or Laramie-Fox Hills aquifers. This form must be completed, signed, dated and submitted to the Commission with a non-refundable $100 filing fee. Type or print in black ink.
1. APPLICANT INFORMATION applicant must control the subject water right
Name of Applicant
Applicant Mailing Address
Applicant Telephone Number (include area code)
2. DETERMINATION NUMBER -
3. DESCRIPTION OF PROPOSED CHANGE provide a complete description of the proposed change(s) in the following spaces - CHANGE USE OF GROUND WATER describe all proposed beneficial uses
- CHANGE PLACE OF USE provide a complete legal description of the proposed place of use if the legal description is too
lengthy for this space, provide the description as an attachment to the application
- DECREASE OR EXCLUDE ALLOWED ANNUAL AMOUNT OF ALLOCATION describe proposed change
- OTHER CHANGES IN THE CONDITIONS OF THE DETERMINATION describe proposed change(s)
4. SIGNATURE OF APPLICANT must be original signature - I have read the statements herein, know the contents thereof, and
state that they are true to my knowledge.
Signature - print name and title
Date
FOR OFFICE USE ONLY
DIV_______ CO_______WD______BASIN________MD_______
Form GWS-67(6/2006)