Certificate of Notice

APPLICATION FOR APPROVAL OF PLAN FOR AUGMENTATION AND CERTIFICATE OF NOTICE

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):

APPLICATION FOR APPROVAL OF PLAN FOR AUGMENTATION

“Plan for augmentation” means a detailed program, which may be either temporary or perpetual in duration, to increase the supply of water available for beneficial use in a division or portion thereof by development of new or alternate means or points of diversion, by a pooling of water resources, by water exchange projects, by providing substitute supplies of water, by the development of new sources of water, or by any other appropriate means.

Generally, the statutes and case law require that injurious out-of-priority depletions must be replaced in time, location, quality and amount.

1. Name, mailing address, email address and telephone number of applicant(s)

2. Name(s) of structure(s) to be augmented.

Structure name(s):

A. Is structure decreed? Yes No

Case number: Name of Court:

Legal description of structure as described in most recent decree that adjudicated the location:

Appropriation date:

Amount in gallons per minute (gpm), cubic feet per second (cfs), or acre-feet:

Source of water:

Decreed uses:

Are there other water rights diverted from this structure(s)? Yes No

If yes, identify court case number(s) and court(s):

B. If the structure is not decreed, provide the legal description of structure:

UTM coordinates

Zone 12 Zone 13

Street Address:

Source of UTMs:

Accuracy of location displayed on GPS device:

Legal Description Using the Public Land Survey System (PLSS) (Optional)

Source of PLSS information:

Street Address:

3. Water right(s) to be used for augmentation:

A. Date of original and all relevant subsequent decrees: Case No:

Court:

B. Type of water right: surface underground storage other

C. Legal description of each point or diversion storage structure:

D. Source of water:

E. Appropriation Date:

Amount to be included in this plan for augmentation:

G. Decreed uses:

4. Does the Applicant intend to change a water right to provide a source of augmentation? Yes No

5. Complete statement of plan for augmentation.

B. Does the plan for augmentation include an exchange that the Applicant desires to adjudicate? Yes No

6. Name(s) and address(es) of owner(s) or reputed owner(s)

VERIFICATION AND ACKNOWLEDGMENT OF APPLICANT OR OTHER PERSON HAVING KNOWLEDGE OF THE FACTS STATED IN THIS APPLICATION

I being first duly sworn, 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.

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:

The person signing this verification is: Applicant Engineer Other

Certificate of Notice

I, hereby certify that I have provided a copy of the application filed on with the Court to the following 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:

The application was provided to the landowner(s) by Certified Registered mail return receipt requested, within 14 days after the application was filed with the Court.