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57 <br />.D&ISI OF RECLAMATION, AINING AND SAFETY <br />Com leteness Notices Checklist <br />Operator <br />/County Planning Depart <br />Specify County: <br />County Commissioners <br />Specify County: <br />boil Conservation Distric`` <br />Specify SCD: <br />♦ '/Municipalities (IfApp 'cable: Tint miles of Operation} <br />Specify: <br />/Army Corps of Engineers <br />Circle One: Colorado/Gunnison <br />Frisco <br />Durango <br />Southern Colorado <br />X♦ /Division of Wildlife <br />Circle One: <br />Nw NE <br />Sw s <br />❑ ♦ Urban Drainage (If Applicable: Within 100 yearfloodplain —Adams, Arapahoe, Boulder, <br />Denver, Douglas and Jefferson counties) EPS Circle One: Y N <br />X f <br />♦ VAir Pollution (1health Department) f <br />♦ VHistorical Society <br />State Land Board <br />J Water Quality (Health Department) <br />xl,'j <br />r <br />Water Resources �r <br />C'.; a BLM (If Applicable) EPS Circle One: Y N <br />JJ Forest Service (If Applicable) EPS Circle One: Y N <br />♦ - Receive one paper copy of Application form, Legal Description and Location Map <br />.� - Receive CD of entire application <br />