2014-08-08_REVISION - M1989024

• Permit No: M1989024
• IBM Index Class Name: REVISION
• Doc Date: 8/8/2014
• Doc Name: Notices SL01
• From: DRMS
• To: Various
• Type & Sequence: SL1
• Email Name: TOD
• Media Type: D
• Archive: No

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10. Correspondance Information
APPLICANT /OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: Jeannette & Edward M. Yaklich
Company Name: N/A
Street: 1120 County Road 129
City: Westcliffe,
State: Colorado Zip Code: 81252
Area Code: 719 Telephone: [phone]
PERMITTING CONTACT (if different from applicant /operator above)
Individual's Name:
Company Name:
Strut:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTIO14 CONTACT (if different from applicant /operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
11. Primary future ❑
Cropland(CR) ❑ Pastureland(PL)
❑
General Agriculture(GA)
land use ❑
Rangeland(RL) ❑ Forestry(FR)
M
Wildlife Habitat(WL)
(check one): ❑
Residential(RS)❑ Recreation(RC)
❑
Industrial /Commercial(IC)
❑
Developed Water Resources(WP)
❑
Solid Waste Disposal(WD)
12. Primary present ❑ Cropland(CR) 11 Pastureland(PL) ❑ General Agriculture(GA)
land use ❑ Rangeland(RL) ❑ Forestry(FR) ❑ Wildlife Habitat(WL)
(check one): ❑ Residential(RS) ❑ Recreation(RC) ❑ Industrial /Commercial(IC)
❑ Developed Water Resources(WR)
To the best of my knowledge, all the information presented on this application form and
the attached Exhibits A -G are true and correct (m4o be signed by_ ap/ icant /operator).
Date: Februar:, 23, 1989 8y: !
Kam*e U