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•. <br /> <br />-2- <br />10. Correspondence Information <br />APPLICANT/OPERATOR (name, address; and phone of name to be used on permit) <br />c, B...ez~L.Ph¢7y.r csc. Pt~gvr~.d fiy ne v... LJ'/1 <br />Individual's Name: Jc(to.•r'EF•~i•M)h~ °^~OFT'T`' Z"e"'~"'~-"~'3 <br />Company Name : El+cC-, L E - C, yr''S u.•r„ P 20 D v ~A-c o ~ ten, ~,~.rr va-,l.-az) <br />Street: o u -S' z . CIIXLNn6~s ,t+.~. p. Ct (Dak /G 3 b <br />Ci ty : E i°cr-~ LE <br />State: Co ~enkno Zip Code: b /G ~ ~ <br />Area Code: -~y o~ Telephone: 3 is - t o g a <br />Company Name: Jntcwr~ r~,~,•..,~,,._.~ /a-~s:~.,,~{•..y ~ .-,c <br />Street: ~• p, nj~yo (~-~[^S <br />City : C~ i ~,,,r.~,os.o S O ~N-a^, 5 Cfl"~ <br />State: ~o sti Zip Code: S ISO Z, <br />Area Code: -'y o~ Telephone: ~ y~ z ~''95'e, <br />INSPECTION CONTACT (if different from applicant/operator above) <br />PERMITTING CONTACT (if different from applicant/operator above) <br />Individual's Name: ~.- ~~.r.-.•r~ l ~-:-s„~,r <br />Individual's Name: <br />Company Name: <br />Street: <br />City: <br />State: <br />Area Code: <br />Zip Code: <br />Telephone: <br />11. Primary future _ Cropland(CR) Pastureland(PL) General Agriculture(GA) <br />land use _ Rangeland(RL) ` Forestry(FR) ` Wildlife Habitat(WL) <br />(check one): Residentiai(RS) ` Recreation(RC) ` Industrial/Commercial(IC) <br />Developed Water l?-sources(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 T~esources(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 signed by applic nt/o era tor). <br />Date: / ~ Z ~ ~ 9 ~ ~~ <br />~, cwt,.-P-~r~- e 6~*+~ - <br />G 7 p~c~-, c r~ e ~, ~- o~ y-H~- <br />t e Tcu~ ~ w, ~d/c.~--~ {r,~a~a~s~- <br />