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<br />10. Correspondance Information
<br />APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
<br />Individual 's Name: k , (Z. t1J ,a7/„~.L
<br />Company Name: (.~ ~'in~ /ne-~r~ ,y e+~.iA..ti 1 ,,,.e, ,
<br />Street: n ~,,,~, ~ ~ g
<br />City : ':1.(~n,a.~„eosl, Sea.u...~
<br />State: C, o Zip Code: gi `~ ~
<br />Area Code: 3O ~ Telephone: 9 ~~ -8~ ~~
<br />PERMITTING CONTACT (if different from applicant/operator above)
<br />Individual 's Name: ~ ~,,l,..,_ F /.f ~,,.,.,d„„
<br />Company Name: (,~,dt,nv. /r/a.(,.~,(, /L1y~,,a,,,. ~,,,~,
<br />Street: ~p Quest zi.s'8A
<br />city: [jam G o ~3 o a a~
<br />State: ~ Zip Code:
<br />Area Code: 3e3 Telephone: ~s-~-y3s~
<br />INSPECTION CONTACT (if different from applicant/operator above)
<br />Individual 's Name: ,~ (Z , ~ ,,~,~1~
<br />Company Name: [.t),,,,~,n„ /71e./,<;(e ,il,,,~fun,Y, ~ ,„~ .
<br />Street: A~.~r~, 3 [~ 8
<br />C i ty ~ ~Jynu+~e o-aQ Sde.u..~ e
<br />State: ~ Zip Code: ~i ~ a 1
<br />Area Code: 30.4 Telephone: g5/S'-86.2
<br />11. Primary future Cro land(CR) Pastureland(PL) General Agriculture(GA)
<br /> land use n e an 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) n ustr a/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 attached Exhibits A-P are true and correct (must be signe by applicant/operator).
<br />Date: C~,1 ~ , /9 9 ~ ay:
<br /> __ ~ n ~ ~
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