PERMFILE62500

• Permit No: M1977163SG
• IBM Index Class Name: Permit File
• Doc Date: 5/22/1987
• Doc Name: REGULAR 112 OPERATION APPLICATION PACKAGE
• 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:
Company Name: Lincoln County
Street: County Courthouse
City: Huao .
State: Colorado Zip Code: 80821
Area Code: 303 Telephone:
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name: Same
Street:
City:
State:
Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name: Same
Street:
City:
State: Zip Code:
Area Code: Telephone:
li. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use. g] 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) O General Agriculture(GA)
land use ~C) 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-P are true and correct (must be signed by applicant/operator).
Date: ~sv ~s. i~`.' By: LINCOLN COUNTY COMMISSION
Tritle