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<br /> <br />-2- <br />10. Correspondance Information <br />APPLICANT/OPERATOR (name., adndress, and phone of name to be used on permit) <br />Individual's Name: RIL~.~Y W /~/%C r/Ec 1. <br />Company Name: /-/~~(fF_1/ /DiT <br />Street: l~~~ ~x l~0 <br />City : 1~76NNF-~-T ~°~ <br />State: C~~~Cl~c~On Zip Code: ~nip~ <br />Area Code: ~7_ Telephone: / ~/~/-- ~//D.~ <br />PERMITTING CONTACT (if different from applicant/operator above) <br />Individual's Name: <br />Company Name: <br />Street: <br />City: <br />State: Zip Code: <br />Area Code: Telephone: <br />INSPECTION CONTACT (if different from applicant/operator above) <br />Individual's Name: <br />Company Name: <br />Street: <br />City: <br />State: Zip Code: <br />Area Code: Telephone: <br />C Crld;n.'H7ic N ~ G-R R¢rk ~t5&~ ~E~ Fq~,a( D~R~iO N <br />11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ~ General Agriculture(GA) <br />land use ^ Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL) <br />(check one): ^ Residential(RS)^ Recreation(RC) Industrial/Commercial(IC) <br />^ Developed Water Resources(WR) ^ Solid Waste Disposal(WD) <br />12. Primary present ^ Cropland(CR) ~ Pastureland(PL) ^ General Agriculture(GA) <br />land use ^ Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL) <br />(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial /Commercial(IC) <br />^ Developed Water Resources(WR) <br />To the best of my knowledge, all the information presented on this application form and <br />the attach//ed Exhib/i~ts A-G arpe true and correct (must be signed b~~y,a//ppl~ilca/~nt/operator). <br />Date: /-h_6~ ~ -/ ~ /~ BY ~ ~3~Y ~yJ ./// <br />C^WN€Jl <br />Tit e <br />