PERMFILE46039

• Permit No: M1988021
• IBM Index Class Name: Permit File
• Doc Date: 3/18/1988
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

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-2-
10. Corre~spondance Information
APPLII;ANT/OPERATOR (name, address, and phone of~name to be used on permit)
Individual's Name: f/,eq~•i'S ,L. ,(~PS/e,e
Company Name: `T~. ~XCaa;a-f;nnJ
:street:
(:i ty
:Mate:
~ //.3L
Area Code: 3G3 Telephone: l~S"7 -.2 `/93
PERMITTING CONTACT (if diffe
re
nt from
applic ant/operat
or above)
Individual's Name: /
/
/
/~/~iJgzd q,r.C~ /
~,u,,~a` ~~-,•+6
l:ompany Name:
:street:
city:
State:
Area Code:
INSPE(:TION CONTACT
QE/-e'. Zip Code: Q`'//3n
~9> Telephone: ~rS~ ~Z,Z9S
(if different from applicant/operator above)
::ndividual's Name:
(:ompany Name:
;street:
(:i ty
State:
Area Code:
11. Primary future
land use
(check one):
12. Primary present
land use
(check one):
Zip Code:
Telephone:
^ Cropland(CR) m Pastureland(PL)
^ Rangeland(RL) ^ Forestry(FR)
^ Residential(RS)^ Recreation(RC)
^ Developed Water Resources(WR)
^ Cropland(CR) (g Pastureland(PL)
p Rangeland(RL) ^ Forestry(FR)
^ Residential(RS) ^ Recreation(RC)
^ Developed Water Resources(WR)
^ General Agriculture(GA)
^ Wildlife Habitat(WL)
^ Industrial/Commercial(IC)
^ Solid Waste Dispoeal(WD)
^ General Agriculture(GA)
^ Wildlife Habitat(WL)
^ Industrial/Commercial(IC)
To the best. of my knowledge, all the information presented on this application form and
the attached Exhib/its AG-G are true and correct (must be igned by applicant/operator).
Date: 3 ice - 2J ~ By• -
P,e
i e