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f I 1I a rS~Bt~ CD o o HO c»j P-CD ?d (D 3<-+? £o <v Under Permit No. PROOF OF APPLIC ATIO N OF W ATE R TO BEN EFIC IAL USE DEPOSITION OF PERMITTEE Note—Questions 1 to 12, inclusive, must be answered regardless of the purpose for which your permit for water has been granted. I f this proof is made for irrigation purposes, a cultural map showing actual boundaries o f land irrigated, together with classes of culture, etc., must accompany same, uidess such map has already been tiled. (See Sec. GO, Chapter 140, Statutes 1013.) Question 1. What is your name, occupation, and post-office address? Answer: ........................................... ...................................... .................................. Question 2. Are you acting in behalf of a corporation? I f so, state its name, place of business and your authority for acting in its behalf. A n sw er:........ .............................. ............................................... Question 3. What is the number of the permit under which this proof is made ? Answer 1 rL *-/( Question 4. From what source do you obtain your tvater supply ? A n sw er:................ ;......... 1............... Question 5. What is the name of the canal, conduit, or other works by which water is conducted to its place of use ? A n sw er:............................................................. Question 6. Are you the person to whom the permit was issued? If not, state how you obtained it giving the succession of title. A n sw er:..... .......................................... . ( I f assignments o f title are not on tile in the office o f the State Engineer, the certificate will issue to the original applicant.) Question 7. For what purpose are you using the water for which you are now making proof? A n sw er:.......................... ............ ............ ,..................................... . Question 8. How many cubic feet per second of water, or fraction thereof, have you actually diverted and beneficially used for the purpose for which this proof is made? (Actual measurement of water shall be given. 40 miners’ inches equals 1 cubic foot per second. I miners’ Inch equals 11.21 gallons per minute. 448.83 gallons per minute equals 1 cubic fodt per second.) A n sw er:................... .............. .......................... ............ Question 9. State the period during the year when water has been beneficially used. Answer: ................................ ......... .................... ................ .......... Question 10. Do you divert and use more water at periods than granted in the permit for which proof is made? If so, make proper explanation. Answer: ...:...... .................. ..................... ................................................................ Question 11. Give date when water measurements were taken, the point at which such measurements were taken and the name and address of persons who made the measurements. Answer: