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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):

Case Number:
Phone Number: E-mail:
FAX Number: Atty. Reg. #: Division: Courtroom:
APPLICATION FOR UNDERGROUND WATER RIGHTS
IN THE DENVER BASIN AQUIFERS

1. Name, 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 Address Email address Telephone

Number

If multiple applicants are listed the following must be completed:

 All of the applicants listed have joint ownership of the parcel(s), and/or joint consent to withdraw the water
underlying the parcel(s), which is/are the subject of this application.

 The Applicants own separate parcels of land, and/or have consent to withdraw the water underlying
separate parcels of land, and request that this Court determine that Applicants have the right to withdraw
all of the legally available groundwater lying below all of the subject parcels of land, through a single well
or multiple wells constructed at any location on the subject parcels of land. In addition the applicant
claims:

 All of the parcels of land claimed in this application are contiguous (that is, no part of land claimed in the
application is physically separate from the rest of the land), or

 The parcels are non-contiguous but could satisfy Rule 11.B of the Statewide Nontributary Ground Water
Rules (2 CCR 402-7) as demonstrated by the attached information (documentation of such claim must be
attached). Please see the instructions regarding this Rule if the applicant has questions.

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2. Background:

A. Parcel description information (if multiple parcels are being described the information shown below must
be provided for each parcel along with a map and legal description of the parcel, as an attachment)

The parcel of land consists of ________ acres, more or less, in ___________ County (or Counties),
located generally in Section(s) ___________, Township(s) ________, Range(s) __________, of the 6 th
Principal Meridian (attach a map). A legal description of the subject parcel of land is attached
hereto (“Subject Property”)

B. Parcel ownership:

The claim of Applicant(s) to the water underlying the parcel(s) described in 2A is based on ownership of
the parcels: Yes No.

If No, the Applicant must provide a) the written consent from the owner(s) of the overlying land to the
applicant, which consent includes a legal description of the land and identification of the aquifers for which
consent has been given, and b) an instrument evidencing ownership of such land by such consenting
owner(s) at the time such consent was granted.

C. This application seeks a decree adjudicating all or part of the nontributary and not nontributary ground
water in the Denver Basin aquifers underlying the Subject Property. Such aquifers may include the Upper
Dawson, Lower Dawson, Denver, Upper Arapahoe, Lower Arapahoe and Laramie-Fox Hills aquifers; the
actual aquifers will be those that are determined to be available underlying the Subject Property in
accordance with the Denver Basin Rules (2 CCR 402-6).

 The Applicant(s) seek to adjudicate the Denver Basin ground water underlying the Subject Property in
all of the available aquifers, or

 The Applicant(s) seek to adjudicate the Denver Basin ground water underlying the Subject Property in
all of the available aquifers, except for the following aquifer(s): _________________________________.

The Applicant(s) may seek to not adjudicate a portion of the water in one or more of the claimed aquifers.
If the Applicant(s) desire to not adjudicate a portion of the Denver Basin ground water the aquifers and
amounts, in acre-feet per year, sought to be excluded from the decree must be specified
___________________________________________________________________________________.

D. Applicant certifies (check one as appropriate):

That Applicant(s) own the Subject Property free and clear of all liens and encumbrances and that no
other person or entity has a financial interest in the Subject Property. Accordingly, Applicant certifies
compliance with the notice requirements of § 37-92-302(2), C.R.S.

 All record owners of the Subject Property not listed as Applicants herein, and every person who has a
lien or mortgage on, or deed of trust to, Applicant’s Property, will be notified of the filing of this Application
by certified or registered mail, return receipt requested, no later than 14 days after the filing of this
Application. Complete and file with the Court the attached Certificate of Notice as evidence that the
required notices were given.

E. There are ____ wells located on the property. Those wells are permitted/registered under well permit
no(s).

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F. The application is seeking to adjudicate the existing well(s) located on the property (If this application has
more than one applicant, owning or claiming consent for separate parcels of overlying land, the existing
wells cannot be adjudicated under this application): Yes No.

An Exhibit 1 must be completed and provided for each well that will be adjudicated, if the
Applicant is not seeking to adjudicate a well, Exhibit 1 is not required.

3. Remarks:

______________________________________________ ______
Signature of Applicant(s) (if self-represented) or Attorney Date

VERIFICATION AND ACKNOWLEDGMENT OF APPLICANT OR OTHER PERSON HAVING

KNOWLEDGE OF THE FACTS STATED IN THIS APPLICATION

Being first duly sworn, I hereby state that I have read this Application, that I have personal knowledge of the facts
stated and, that I verify its contents to the best of my knowledge, information, and belief.

____________________________________________
Signature Date

The foregoing instrument was acknowledged before me in the County of ________________, State of Colorado,
this ____day of ____________, 20___, by the person whose signature appears above.

My Commission Expires: ________________

_____________________________________________
Notary Public/Deputy Clerk

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Exhibit 1 - Page ____ of _____

1. Name of well and permit or registration (Attach a copy of the well permit or registration).

Name of Well Permit or Registration Number

2. Required 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; 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 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): Include perpendicular distances from section lines, and indicate ¼ ¼,
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 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 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: Section Township Range Principal

______1/4 _____1/4
County _______ _______ Meridian
of the
N or S E or W
 
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

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3. A. Source (Identify aquifer into which well is drilled):

B. Depth to bottom of well: feet

4. A. Date of appropriation:
B. How appropriation was initiated:

C. Date water applied to beneficial use:

5. A. Claimed Pumping Rate: gpm

B. Amount claimed in acre-feet annually:

6. Proposed use (A through D must only be completed if the Applicant is seeking to adjudicate an exempt well
permitted pursuant to § 37-92-602, C.R.S.):

A. Number of single-family dwellings served

B. Area of lawns and gardens irrigated square-feet acres

C. Domestic animals watering Yes  No
D. Livestock watering on farm/ranch/pasture (property must be 35 or more acres ) Yes No

E. Other uses (describe fully):

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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):

Case Number:
Phone Number: E-mail:
FAX Number: Atty. Reg. #: Division: Courtroom:
Certificate of Notice

Note: § 37-92-302(2)(b), C.R.S. requires that the application shall be supplemented by evidence that the
applicant has, within 14 days after filing the application, given notice of the application by registered or certified
mail, return receipt requested, to every record landowner of the overlying land and to every person who has a lien
or mortgage on, or deed of trust to, the overlying land recorded in the county in which the overlying land is
located. Complete this form and file it with the Water Court after the subject notices have been given.

I, ________________________________________________ (insert name) hereby certify that I have

provided a copy of the application filed on ____________________ (date) with the Court to the
following record owner(s) of the overlying land and person(s) who has a lien or mortgage on, or deed
of trust to, the overlying land recorded in the county in which the overlying land is located; and if
applicable to the owner(s) of the land upon which any new diversion or storage structure or modification
to any existing diversion or storage structure or existing storage pool is or will be constructed or upon
which water is or will be stored:

1. ___________________________________________________
2. ___________________________________________________
3. ___________________________________________________

The application was provided to the landowner(s) by Certified or Registered mail, return receipt
requested, within 14 days after the application was filed with the Court and is attached to this Notice.

Date: __________________________ _____________________________________

Signature/Title

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