REV16909

• Permit No: M1977559
• IBM Index Class Name: Revision
• Doc Date: 2/23/1987
• Doc Name: REGULAR 112 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: Ed Stewart
Compdny~Name: Valco, Inc.
Street' 730 S. MacKehzie ~^
City: Canon City
State: Colo. Zip Code: St2t2
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPEGTION 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) m Pastureland(PL) ^ General Agriculture(GA)
land use p Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR)
To the best of nl1' knowledge, all the information presented on this application form and
the attached Exhibits A-P are true and correct ustcbe '~i~g~,'ne~d by applicant/operator).
Date' ~ "~~ ` ~ ~ BY~ ~,' ~_J~ y 1 ~~
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