PERMFILE41511

• Permit No: M1990106
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

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10. Correspondence Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: uonda Dockter
Company Name: R_R_K_ Construction, Inc.
Street: pn Rnx 376
City: Rye,
State: Colorado Zip Code: 81069
Area Code: 719 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: Richard Simpson
Company Name: RBK Construction, Inc.
Street: PO Box 376
City: Rye
State: Colorado Zip Code: 81069
Area Code: 719 Telephone: [phone]
INSPECTION 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) ~ Wildlife Habitat(WL)
(check one): ^ Residential(RS)O Recreation(RC) ^ IndustriallCommercial(IC)
O Developed Water Resources(NR) ^ Solid Waste Disposal(WD)
12. Primary present ^ Cropland(CR) ® Pastureland(PL) ^ General Agriculture(GA}
land use . O Rangeland(RL) ^ Forestry(FR) ^ Nildlife HabitAt(WL)
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial /Commercial(IC)
^ Developed Water Re sources(WR)
To the best of my knowledge, all the informs n p ented on thi application form and
the attached Ex
h
ib
i
ts A-G are true and cor ct (must b sig ned bar appli antjoperator).
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