PERMFILE50907

• Permit No: M1988018
• IBM Index Class Name: Permit File
• Doc Date: 6/7/1988
• Doc Name: REGULAR 112 OPERATION APPLICATION PACKAGE
• Media Type: D
• Archive: No

. -2-
10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
'ndividual's Name:
Company Na:ne: _ Mi[~u".~/ Saul R (:ravPt~ me-.
Street: _ p_~_ Rnx 353
(.i ty: Fnrm Lain
State: r~tnrarln Zio Code: 80817
Area Code: 7tg Telephone: 3R7_~tq
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:
Company Nacre:
Street:
City:
State: Zip Code:
Area Code: Telephone:
ll. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA}
land use J4 Rangeland(RL) ^ Fore;stry(FR) O Wildlife Habitat(WL)
(check one): ^ Residential(RS)^ Recr•eation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR) ,. Solid Baste Disposal(k'D)
12. Primary present ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use 29 Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resour~es(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 sig/ne 6/y//applicant/operator).
Date: iyatshq, 1988 BY_~ ~ a- .c/~_
t tT~e E~-