PERMFILE44118

• Permit No: M1988018
• IBM Index Class Name: Permit File
• Doc Date: 3/10/1988
• Doc Name: REGULAR 112 PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

-2-
10. Corresponiance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name:
Company Name: M;/if.ra~ Sarxl R (;ravalFjnc.
C1 ty : Fn~mtain
Stat>: r„~n,.~n Zip Code: 80817
Area Code: ~ig Telephone: 3R9-~1q
PERMIITIlH~ CONTACT (if different from applicant/operator above)
Indi~ridual's Name:
Company Name:
Street:
City:
Mate:
Area Code:
Zip Code:
Telephone:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Na me:
Company Name:
Street:
City: _
State: ` Zip Code:
Area Code: Telephone:
11. Primary future ^ Cropland(CR) D Pastureland(PL) D General Agriculture(GA)
land use ^ Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS)^ Recreation(RC) „ end nm ial IC)
^ Developed Water Resources(WR) ~~j Solid Waite Disposal(WD)
"
~ ~~
12. Primary present ^ Cropland(CR) ^ Paftureland(PL) ^ General Agriculture(GA)
Tand use ~ Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) p Recreation(RC) ^ Industrial/Commercial(IC)
p Developed Water Resources(WR)
r-.
To the best of my knowled ge, all the information presented on this application form and
the attached Exhibits A-P are true and correct (must be signed by pplicant/o/operator).
Dat e: ~~ q_ 198g By: ~ ~ ./i ~ ii!/l
Pr_~y
i e