PERMFILE40453

• Permit No: M1987020
• IBM Index Class Name: Permit File
• Doc Date: 2/10/1987
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• 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' Vern Rominger, Chairman
Company Name: Rio Grande County
Street' 6th & Cherry P. 0. Box 396
City: Del Norte
State: co Zip Code: 81132
Area Code: 303 Telephone: [phone]
PERI4ITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name: Fred olme, Supervisor
Company Name: Rio Crande County
Street' 168 N. Washington P. 0. Box 46
City: Monte Vista
State: co Zip Code: 81144
Area Code: 303 Telephone: as2-4781
11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use ®c Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS)^ Recreation(RC) ^ Industrial/Commerclal(IC)
^ Developed Water Resources(WR) ^ So11d Waste Disposal(WD)
12. Primary present ^ Cropland(CR) ^ Pastureland(PL) p General Agriculture(GA)
land use 6C7t Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) O 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 (must be //s//igned by ap licant/operator).
Date: ~-x/987 BY: !/1/Lrt/
~~
Chairman of the Board
t e