PERMFILE69072

• Permit No: M1987097
• IBM Index Class Name: Permit File
• Doc Date: 6/1/1987
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• 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: Coneios County Road and Bridge Deot.
Company Name: coneios county
Street: P. 0. Box 157
City: Cone;os Colorado
State: colorado Zip Code: x1129
Area Code: 3n3 Telephone: 37~_Sr,sa
PERMITTING CONTACT (if different from applicant/operator above)
IndlVidUa1'S Name: Joe D. Rom o 1 - Road Sunerinrvndant
Company Name: cone ^os Gounty
Street: P. o. aox is7
City: Conej9s
State: colorado Zip Code: a1129
Area Code: 303 Telephone: 37fi_S~i37
INSPECTION CONTACT (if different from applicant/operator above)
IndiVldUal'S Name: Mr. Pete L. DeHerrera
Company Name:
Street: P. n. Box 7zb
City: Antonito, Colorado
State: colorado Zip Code:
Area Code: 3Q3 Telephone: 376-239a
11. Prirnary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use %B 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. Prirnary present ^ Cropland(CR) ^ PasturelandiPL) ^ General Agriculture(GA)
land use %H Rangeland(RL) ^ Forestry(FR) ^ Wildlife Nabitat(WL)
(cheek one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Re sources(WR)
To the bust of rrry 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: _ .~~o?G~87 BY~ ?I//~' ~~
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