Fill and Sign the Surface Right Form

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): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division: Courtroom: APPLICATION FOR  CONDITIONAL  ABSOLUTE WATER RIGHTS (SURFACE) It is the applicant’s responsibility to provide the location for each structure in this application. For structures that are already decreed, use the location from the most recent decree that adjudicated the location. UTM coordinates (for example from a GPS device) or measured distances in the field from known section lines are acceptable. The Division Engineer, the Water Referee, or the Water Judge may order the applicant to confirm the location of any structure with UTM coordinates, a survey, or other method. 1. Name, mailing 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 Mailing Address Email address Telephone Number 2. Name of structure:  ditch  spring  other _____________________. 3 . Legal description of each point of diversion: 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. A ttach a legible 8 ½ x 11 inch map to this application illustrating location of the structure. UTM coordinates Easting ___________________ Northing _____________________  Zone 12  Zone 13 Street Address:_______________________________________________________________________ Subdivision: Lot Block JDF 296W R8/17 APPLICATION FOR WATER RIGHTS (SURFACE) AND CERTIFICATE OF NOTICE Page 1 of 5 © 2017 Colorado Judicial Department for use in the Courts of Colorado 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: County ______1/4 of the _____1/4 Section Township _______ N or S  Range _______ E or W  Principal Meridian 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 4. Source: (for example, unnamed tributary to North Clear Creek, tributary to Clear Creek, tributary to the South Platte River) 5. A . Date of appropriation: B. How appropriation was initiated: C . Date water applied to beneficial use: 6 . Amount claimed in cubic feet per second (cfs) or gallons per minute (gpm) (1 cfs = 448.8 gpm). Conditional _____________ (  cfs  gpm) Absolute ________ (  cfs  gpm) If claiming an absolute water right, application shall include supporting evidence that applicant diverted water in-priority and applied such water to the beneficial uses claimed in the amounts claimed. 7. List All Uses or Proposed Uses: A. If irrigation, complete the following: Number of acres historically irrigated _____________; proposed to be irrigated ___________________. JDF 296W R8/17 APPLICATION FOR WATER RIGHTS (SURFACE) AND CERTIFICATE OF NOTICE Page 2 of 5 © 2017 Colorado Judicial Department for use in the Courts of Colorado Does the Applicant intend to use this water right to supplement irrigation on an area of land already irrigated under another water right?  yes  no Legal description of irrigated acreage. Mark the location of the irrigated acreage 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. B. If non-irrigation, describe purpose fully. Mark location of use 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. 8. Name(s) and address(es) of owner(s) or reputed owner(s) of the land upon which any new or existing diversion or storage structure, or modification to any existing diversion or storage structure is or will be constructed or upon which water is or will be stored, including any modification to the existing storage pool. The applicant must notify these persons that the applicant is applying for this water right, and certify to the Court that the applicant has done so by no later than 14 days after filing this application. The certification form is on page 4 of this form. Name of Owner Mailing Address 9. Remarks or any other pertinent information:  By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form.  By checking this box, I am acknowledging that I have made a change to the original content of this form. (Checking this box requires you to remove JDF number and copyright at the bottom of the form.) ______________________________________________ _________ Signature of Applicant(s) (if self-represented) or Attorney Date JDF 296W R8/17 APPLICATION FOR WATER RIGHTS (SURFACE) AND CERTIFICATE OF NOTICE Page 3 of 5 © 2017 Colorado Judicial Department for use in the Courts of Colorado 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. ____________________________________________ 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 The person signing this verification is:  Applicant  Engineer  Other (describe) ____________________ Verifications of other persons having knowledge of the facts may be attached to this Application. JDF 296W R8/17 APPLICATION FOR WATER RIGHTS (SURFACE) AND CERTIFICATE OF NOTICE Page 4 of 5 © 2017 Colorado Judicial Department for use in the Courts of Colorado 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): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division: Courtroom: Certificate of Notice I, (insert name) hereby certify that I have provided a copy of the application filed on (date) 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: 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. Date: __________________________ _____________________________________ Signature/Title JDF 296W R8/17 APPLICATION FOR WATER RIGHTS (SURFACE) AND CERTIFICATE OF NOTICE Page 5 of 5 © 2017 Colorado Judicial Department for use in the Courts of Colorado