PERMFILE57502

• Permit No: M1988022
• IBM Index Class Name: Permit File
• Doc Date: 3/18/1988
• Doc Name: LIMITED IMPACT OPERATION 110 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)
]ndividual's Name:
Company Name: Lincoln Gountp
Street: (;ourthouse
City: Hueo
State: Golo. Zip Code: $0$21
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: J.k. Owen
Company Name:
Street: 21$ 8th St.
City: Hugo
State: cnlc,_ Zip Code: RO$21
Area'Code: 303 Telephone: [phone]
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name: '
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use Q Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
i (check one): ^ Residential(RS)^ Recreation(RC) ^ Industrial/Commercial(!C)
^ Developed Water Resources(WR) p Solid Waste Disposal(WD)
12. Primary present ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use ~7 Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ 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 (must be signed by applicant/operator).
Date: gy; y,~ ~.. ~; ~' is
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