1313 Sherman Street, Room 821-2026

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  1. Click ‘Get Form’ to open the Statement of Pump Installation in the editor.
  2. Begin by entering the date when the Colorado State Engineer issued your well permit number in the designated field.
  3. Next, confirm that a permanent pump was installed on or before the expiration date of your well permit. Ensure this information is accurate.
  4. In the section provided, clearly print the Signer’s Name and Title. This should be completed by the well owner or an authorized agent.
  5. Sign and date the form in the appropriate fields. Remember, any edits must be initialed and dated to maintain clarity.
  6. Once completed, save your document as a PDF. You can then email it to dwrpermitsonline@state.co.us for submission.

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