PERMFILE50576

• Permit No: M1987064
• IBM Index Class Name: Permit File
• Doc Date: 4/16/1987
• Doc Name: APPLICATION FORM EXHIBIT A
• From: SANDCO INC
• To: DMG
• Section_Exhibit Name: EXHIBIT A
• Media Type: D
• Archive: No

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Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: Jahn Dillon
Company Name: _~ardco Inc.
Street: ~ G. Rox 1773
City: Tt~r~r,gQ~
State: L'nlmadn Zip Code: a~~n~
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name _: Same as Above
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name: Same ac e~bovc
Company Name:
Street:
City:
State:
Area Cade:

Telephone:
Zip Code:
11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use ^ Rangeland(RL) ^ Forestry(FR) L~ Wildlife Habitat(WL)
(check one): ^ Residential(RS)p Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR) ^ Solid Waste Disposal(WD)
12. Primary present ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use O Rangeland(RL) ^ Forestry(FR) ~ Wildlife Habitat(WL)
(check one): O Residential(RS) p Recreation(RC) O Industrial/Commercial(IC)
^ Developed Water Resources(WR)
To the best of my knowledge, all the information presented on this application form and
the attached Exhibits A-P are true and correct (must be signed•by applicant/operator).
Date: ~ ~ ,t- , 7 y: r-xi -,. <«~
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