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Ste"— Ar C/ cag)ab 4w-S6 <br />Notification Request - Long List (New Apps, Amendment, or Conversion <br />Permit Specialist: ECS Today's Date: <br />Permitting Action: Select... C�v/ <br />,,/'Permit Number: r <br />Site Name: xr6 � 76 1 <br />Permittee: 64e✓t.V Wf' -r-ele <br />Permittee Address 1: l0(( �l ' 4e <br />Permittee Address 2: <br />City: 6r&�% State: CO Zip: <br />County Name: 4tOgk, j�,Je <br />V/County Commissioners /County Planning Dept. <br />Ounicipalities within 2 Miles of Site: �• ooe///(/ <br />Soil Conservation District: key / &,et <br />ja Colorado Division of Wildlife: Select... A� <br />❑ Urban Drainage - only needed if site is within 100 yr floodplain in Adams, Arapahoe, <br />Boulder, Denver, Douglas or Jefferson Counties <br />WIUS Army Corps of Engineers: Denver Office <br />❑ US Bureau of Land Management - with CD of complete application if site is on BLM land <br />❑ US Forest Service - with CD of complete application if site is on USFS land <br />Include: Application Form, Exhibit A (legal description of property) and Index Map <br />for all notices. <br />Notifications are always sent to: CDPHE Air and Water Quality, OSE Water Resource <br />Division, Colorado State Land Board, and Colorado Historical Society. <br />