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PERMFILE66133
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PERMFILE66133
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Entry Properties
Last modified
8/24/2016 11:12:03 PM
Creation date
11/20/2007 9:11:09 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1989004
IBM Index Class Name
Permit File
Doc Date
1/9/1989
Doc Name
REGULAR 112 PERMIT APPLICATION FORM
Media Type
D
Archive
No
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~; <br />,. <br />-2- <br />10. Correspondance Information <br />APPLICANT/OPERATOR (name, address, and phone of name to be used on permit) <br />Individual's Name: Kit Carson County <br />Company Name: Raymond nuei~ p; t._ <br />Street. Kit. ~.ATSlIn Crn~nt.v Crnmth nnco <br />City: B urlin~ton <br />State: Cola Zip Code: gpg07 <br />Area Code: 719 Telephone: 346-$133 <br />PERMITTING CONTACT (if different from applicant/operator above) <br />Individual's Name: J. R. Owen Commissioner_Dean Stevens <br />Company Name: <br />Street: 21$ $tt. St 21 th St. <br />City: Hu o Flagler , CO $0$15 <br />State: ~~~ Zip Code: 8C182~ <br />Area Code: 719 Telephone: 743-2209 <br />INSPECTION CONTACT (if different from applicant/operator above) <br />Individual's Name: Same <br />Company Name: <br />Street: <br />City: <br />State: Zip Code: <br />Area Code: Telephone: <br />11. Primary future O Cropland(CR) O Pastureland(PL) ^ General AgricuTture(GA) <br />land use ~ Rangeland(RL) O Forestry(FR) ^ Wildlife Nabitat(WL) <br />(check one): ^ Residentiai(RS)O Recreation(RC) O Industrial/Commercial(IC) <br />^ Developed Water Resources(WR) O Solid Waste Disposal(WD) <br />12. Primary present O Cropland(CR) ^ Pastureland(PL) O General Agriculture(GA) <br />land use ® Rangeland(RL) O Forestry(FR) ^ Wildlife Habitat(WL) <br />(check one): O Residential(RS) ^ Recreation(RC) O Industrial/Commer•cial(IC) <br />^ Developed Water Resources(WR) <br />To the best of my knowledge, all the information presented on this application form and <br />the attached Exhibits A-P are true and correct (must~/bedsigned by a/p~plican-t¢/operator). <br />Date : _~ -~ S ' ~ ~ S'~`~ BY ~ ~ ,y7~/ ~crc la-u~r~~ <br />e <br />
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