REV12532

• Permit No: M1980146
• IBM Index Class Name: Revision
• Doc Name: REGULAR PERMIT APPLICATION FORM
• Type & Sequence: AM1
• 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: Jack Gilleland
Company Name: C & J Gravel Products, Inc.
Street: 514 County Road 509
C;ty: Ignacio
State: .Colorado Zip Code: 81137
Area Code: 303 Telephone: g84-2840
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: Garv Tuttle
Company Name: Tuttle Applegate Rindahl, Inc.
Street: 11990 Grant Street, Suite 410
City: Denver
State: Colorado Zip Code $0233
Area Code: 303 Telephone: [phone]
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use ® 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. Primary present ^ Cropland(CR) ^ Pastureland(PL) p General Agriculture(GA)
land use ~ Rangeland(RL) p Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Nater Resources(WR)
To the best of nV' knowledge, all the information presented on this application form and
the attached Exhibits A-P are true and correct (must be signe~ b~ a~~an opera r),
Date: L-l' y - ~~ BY{T ~,C Cc
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