PERMFILE41836

• Permit No: M1987078
• IBM Index Class Name: Permit File
• Doc Date: 3/23/1987
• Doc Name: SPECIAL OPERATIONS III APPLICATION FORM
• Media Type: D
• Archive: No

I/ ~ •
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10. Correspondence Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: Mr. William c. Tt„-aiik+n
Company Name: City of Lamar. a MLnicira.l Coron.~ation _
Street: 104 E. Parmenter P. O. Box 270
City: Lamar
State: Colorado Zip Code: 81052
Area Code: (303) Telephone: [phone]
PERMITTING 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:
C~~mpany 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) ^ Recreation (RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR) ^ Solid Waste Disposal(WD)
12. Primar,~ present ^ Cropland(CR) ^ 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 wy knowledge, all the information presented on this application form and
the attached Exhibits A-G are true and corr~.:'_ !must 5SSa si;-ad by a~pp.,l~icant~/~op~e~rator).
Date : BY : W-JCY-----, ~ ~ ~ -tin+..xf~^~.