PERMFILE46655

• Permit No: M1990131
• IBM Index Class Name: Permit File
• Doc Date: 10/1/1990
• Doc Name: LIMITED IMPACT OPERATION 110 2 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: '„ ~Y,y L~~~-i -Serra A. M•iTr.he~l..
Company Name:
Street: ~f819D E a6 Av-Q C~vX Z~7
City : Q P,~ -/~ 2 t 2'
State: (r n L~, ra d o Zip Code: ~o ~ 0 z
Area Code: Telephone:
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
Telephone:
Zip Code:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
Zip Code:
Telephone:
11. Primary future Cropland(CR) t~ Pastureland(PL) General Agriculture(GA)
land use -_ Rangeland(RL) _ Forestry(FR) _- Wildlife Habiiat(WL)
(check one): Residential(RS) Recreation(RC) Industrial/Commercial(IC)
_ Developed Water 1~esources(WR) _ Solid Waste Disposal(WD)
12. Primary present _ Cropland(CR) rldPastureland(PL) _ General Agriculture(GA)
land use Rangeland(RL) _ Forestry(FR) _ Wildlife Habitat(WL)
(check one): - Residential(RS) Recreation(RC) Industrial/Commercial(IC)
_ Developed Water i~esources(WR)