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' I � � � OFFICE USE ONLY <br /> I <br /> C 0 L IRA <br /> AG tease: <br /> State Land Board -- <br /> Iper m Leases:jkl <br /> ----"_-_-- <br /> • �_)t;,'�?t71-:1T1t_ ,`l "c'. ir_'• +. Llf�'�' <br /> TEMPORARY ACCESS PERMIT APPLICATION tA4 <br /> APPLICANT INFORMATION: <br /> Provide lame and contact Apphcant Name (or reprns "tativei. <br /> rn'ormation for rnam appt,cant. --- — -- -- -'-' --- -- ' — j <br /> odi Schreiber <br /> Company cr Organization (if apphcat:ie)s <br /> A&S Construction Co. <br /> ------- --------------- --- ------------- - --- ---- ------------------ <br /> ------------------- - ------------- ------- -- <br /> 1839 MacKenzie Ave <br /> C,:v: Stete. Zip Code <br /> ---J <br /> - —------- - - ------- <br /> ,Canon City - ----- - -- -- -- -CI ;i81---------------------------- <br /> CO 1212 <br /> Prone fJ;itTi�te" F-�;,a 1 Ndd+ess <br /> 719-529-0916 ; �odi@arycorp.com ---- -- <br /> List atl inai\•iduats who witt oe Addit,ona( mdi ci.,ats accorrpanying app•,cant during temporary access <br /> — ---- - <br /> accorrpai}v na you uwr;g your --- - - — -- -- ----- <br /> ten,JGIarj access I-eddlt,onal Employees of ASS Construction <br /> s oa r_e is -------- - - -- - --- - <br /> � rerLl}r-cC, attach a ------ —'-`----- ------------ I------'---' ---_--"--.--' -- - ----- -- <br /> separ-atc list, Fm s--')cQl -)roups <br /> only ,nctude name cf crass o <br /> Select if tempo~ary access Is Seteet if appt cable arld prutidc Sellout, umrelsty• nr Agency Nave <br /> iota'.ea in auv of the follow,r,c I--- -- - - — - -- --- , <br /> user {-ou s ❑Colorado K-112 PuDuc S:.hcot <br /> Colorado P ihuc Univeisity <br /> State Go,•ertiment A,er-cy 1 <br /> Feder at .:0"ern}-,e;,t?gercv <br /> PROPERTY I14FORMATION: <br /> Apphcanon ,s hereby trade across Jae toltow}ng state lands. if you do not fno,n ti,s ioful groat,m, p'.ease contact your Coca Distract <br /> Off ce At-acn addmonat sheet if necessary <br /> Number of Aces -egal Desc,,pti,,r, Sectlen Township Range Count"; <br /> 640 ALL 16 12S 45W Cheyenne <br /> 640 ALL 16 12S 44W Cheyenne <br /> 640 ALL 16 12S 43W Cheyenne <br /> 1ewpoi-ai" Access Url il,t:+pptiCBt'9n `2 i 1 <br /> .•,ti,. t1.1'•:iCndS slat:, co is Rt�•.. ..'� 9 <br />