PERMFILE61492

• Permit No: M1988115
• IBM Index Class Name: Permit File
• Doc Date: 11/10/1988
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

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10. Correspondence Information
APPLICANT/OPERATOR. (name. address, and phone of name to be used on permit)
Individual's Name: Kit Carson County
Company Name: Same
Street: 251 1 th St.
City: • Burlington
State: Colorado Zip Code: $0$07
Area Code: 719 Telephone: 346-$133 '
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: J.R. Owen
• Company Name: Kit Carson County
Street: 21$ $th St.
City: Hugo
State: Colorado Zi Code: $0$21
Area'Code: 719 Telephone: [phone]
INSPECTION CONTACT. (if different from applicant/operator above)
Individual's Name: Same
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
11. Primary future ^ Cropland(CR) ^ 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) ^ General Agriculture(GA)
land use 01 Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR)
To the best of ny knowledge, all the information presented on this application form and,
the attached Exhibits A-G are true and correct (must be signed /bfy a~pp_licant/operator).
Date: / / - ~' - Q ~ By: ~~~_.._ .A1"~ycs-~.~~
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