PERMFILE51076

• Permit No: M1989024
• IBM Index Class Name: Permit File
• Doc Date: 2/23/1989
• Doc Name: Limited Impact Operation Application Form
• From: EDWARD M YAKLICH
• To: MLRD
• Media Type: D
• Archive: No

-2-
10.
Correspor~dance Information
APPLICANl~/OPERATOR {name, address, and phone of name to be used on permit)
Individual's Name: Jeannette & Edward M. Yaklich
Company Name; N/A
Street: 1120 Cnunty Road 124
City: Westcliffe,
State: Colorado Zip Code: 81252
Area Code: 719 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
Stat~a: Zip Code:
Area Code: Telephone:
INSPECTIOtJ CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City::
$tdtE!:
Area Code:
Telephone:
Zip Code:
11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use ^ Rangeland(RL} ^ Forestry(FR) ® Wildlife Habitat(WL)
(check ones): ^ Residential(RS)^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR) ^ Solid Waste Disposal(WD)
12. Primary present ^ Cropland(CR) 88 Pastureland(PL) ^ General Agriculture(GA)
land use ^ Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): p Residential(RS) ^ Recreation(RC) ^ 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-G are true and correct (m be signed_b,~ap icant/operator).
Febn:ary 23, 1989 ~~~'/'7.(/
Date : By: a~~a~-h