PERMFILE51825

• Permit No: M1988093
• IBM Index Class Name: Permit File
• Doc Name: MLRB REGULAR 112 PERMIT APPLICATION FREMONT PAVING & REDI MIX PIT
• Media Type: D
• Archive: No

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1 10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
' Individual's Name: Phyllis Ary
Company Name: Fremont Paving & Redi-Mix, Inc.
Street: Box 841
' City: Canon City, CO
State: Colorado Zip Code: 81212
' Area Code: 719 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
' Individual's Name:
Company Name:
' Street:
City:
State: Zip Code:
Area Code: Telephone:

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INSPECTION CONTACT (if different from applicant/operator above)
11. Primary future ^ Cropland(CR) p Pastureland(PL) ^ General Agriculture(GA)
land use ® Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS)^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR) ^ Solid Waste Disposal(WD)
12. Primary present ^ Cropland(CR) ^ Pastureland(PL) p General Agriculture(GA)
land use ® Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) J7 Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR)
To the best of my knowledge, all the information pres nted on this application form and
the attached E/xhibits A-G are true and correct (mus b signed b applicant/operator).
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Date: /,,~0~*~iw/5, ~`lk~ BY: %k.~
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Individual's Name:
Company Name: ___
Street:
City:
State: Zip Code: _
Area Code: Telephone:
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