File Number: (For OSE Use Only) NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE LOCATION OF WELL 1. WATER RIGHT OWNER Name: Zeno Mach Contact: Address: Mai Gadon 49 biro Rath Work Phone: Home Phone: City: sun* State: ,a Zip: 117016 2. PURPOSE OF USE Domestic: x Livestock: x Irrigation: x Municipal: Industrial: Commercial: Other (specify): minchess Specific use: 3. QUANTITY Consumptive Use: to acre-feet per annum Diversion Amount: w acre-feet per annum 4. PLACE OF USE 24 acres of land described as follows: Subdivision of Section Section Township Range Acres (District or (Map No.) (Tract No.) Hydrographic Survey) SW W. SW 1/4. NE 1/4 SE IN Is 12N SE 22 12N SE Who is the owner of the land? annwesTmom 20 Do Not Write Below This Line File Number: Trn Number: Form: wr-06 page 1 of 4 EFTA01222821