PERMFILE61132

• Permit No: M1987164
• IBM Index Class Name: Permit File
• Doc Date: 10/16/1987
• 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)
Individual's Name: Jamcs E, Cami]letti
Company Name:
Street: P. 0. Ro>:
City: ]Iay~~en
State: Colorado Zip Code: 81639
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: Daniel N. Ellison
Company Name:
Street: P.0. Boar 77,ri4R
City: Steamboat ~nrinF~s
State: Color°ado Zip Code: 80477
Area Code: ~0; Telephone: [phone]
INSPECTION CONTACT (if different from applicantloperator above)
Individual's Name: Bobby Robinson, Jr
Company Ndme: R. fl. Robinson Con:~truction
Street: F. 0. Scx / ~ j
City: Nayrlen
State: Colorado Zip Code: 81639
Area Code: 303 Telephone: [phone]
11. Primary future ~ Cropland(CR) ^ Pastureland(PL) p General Agriculture(GA)
land use ^ Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS)^ Recreation(RCI ^ Industrial/Commercial(IC)
p Developed Water Resources(WR) ^ Solid Waste Oisposal(WD)
12. Primary present p Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use ^ Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) ^ Recreation(RC1 ^ 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 bet signed by applicant/ope/rotor).
Date: / ) ~/.S~ ~l ~ DY~ l „_~ :~~ ~G~>-ctrl!<~
~`~
r e
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