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REV91064
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REV91064
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Entry Properties
Last modified
8/25/2016 3:12:40 AM
Creation date
11/21/2007 11:08:36 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1977081
IBM Index Class Name
Revision
Doc Date
7/21/1989
Doc Name
REGULAR PERMIT APPLICATION FORM
Type & Sequence
SO1
Media Type
D
Archive
No
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~~. <br />i ~ <br />-2- <br />10. Correspondance Information <br />APPLICANT/OPERATOR (name, address, and phone of name to be used on permit) <br />Individual's Name: John F. Hickman - contact <br />Company Name: Western-Mobile. Inc. <br />Street: 1400 W. 64th Avenue <br />c; ty <br />State: <br />Area Code: <br />PERMITTING CONTACT <br />Denver <br />Colorado Zip Code: R02~i <br />303 Telephone: 426-1166 <br />(if different from applicant/operator above) <br />Individual's Name: <br />Company Name: <br />Street: <br />City: <br />State: <br />Area Code: <br />Telephone: <br />Zip Code: <br />INSPECTION CONTACT (if different from applicant/operator above) <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 x Cropland(CR) x Pastureland(PL) General Agriculture(GA) <br />land use _ Rangeland(RL) - Forestry(FR) - Wildlife Habitat(WL) <br />(check one): _ Residential(RS) - Recreation(RC) - Industrial/Comnercial(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) X Industrial/Commercial(IC) <br />Developed Waterl~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 (mustAbe signed by applicant/operator). <br />Date: May 23, 1989 By:`,-,[_ ~ , ~~ <br />John F. Hickman <br />Manager of Land & Resources <br />rt e <br />
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