PERMFILE64087

• Permit No: M1987019
• IBM Index Class Name: Permit File
• Doc Date: 2/12/1987
• Doc Name: NOTICE OF PERMIT APPLICATION
• From: MLRD
• To: THOMAS E BROTZ
• 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: Vern Rominger, Chairman
Company Name: Rlo Granae County
Street: 6th & Cherry P. 0. Box 396
City: Del Norte
State: CO Zip Code: 81132
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: zhomas E. Brecz
Company Name: ~ State Board of Land Commissioners
Street: 1313 Sherman Street, 620 Centennial Bldg.
'~ City: Denver
State: CO Zip Code: 80203
Area Code: 303 Telephone: [phone]
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name: Fred Olme, Supervisor
Company Name: Rio Grande councy
Street: 168 N. Washington
City: Monte Visa
State: CO Zip Code: 81144
Area Code: 303 Telephone: [phone]
11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use EIt Rangeland(RL) ^ Forestry(FR) ^ Wildlife Nabitat(WL)
(check one): ^ Residentlal(RS)^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR) ^ Solid Naste Disposal(WD)
12. Primary present ^ Cropland(CR) ^ Pastureland(PL) ^ General Agrlculture(GA)
land use ®1 Rangeland(RL) ^ Forestry(FR) ^ Wildlife Nabitat(WL)
(check one): ^ Resldentlal(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: ~ /y~7 By: ~~~/ ..y,~J2liyD1~G'~
Chairman of the Board
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