REV95678

• Permit No: M1977302
• IBM Index Class Name: Revision
• Doc Name: REGULAR 112 PERMIT APPLICATION FORM
• Type & Sequence: AM2
• Media Type: D
• Archive: No

~• -.
-2-

11. Primary future Pastureland(PL)
Cropland(CR) General Agriculture(GA)
land use _
_
Rangeland(RL) Forestry(FR) g Wildlife Habitat(WL)
(check one): -
Residential(RS) - Recreation(RC) - Industrial/Commercial(IC)
_
Developed Water 1Fesources(WR) - Solid Waste Disposal(WD)
12. Primary present 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 l~sources(WR)
_
To the best of my knowled e, all the information res t d
9 P / this a licatio form and
~ PP 9,
the attached Exhibits A-P are true and correct (must si ed/~y appli~a,nt. Aerator).
Date: February 8, 1989 gy;
10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: Robert s. Olson
Company Ndme: Colorado Lien Company
Street: P. 0. Box 1961
Clty: Ft. Collins
State: co Zip Code: 8052::
Area Code: ~n~ Telephone: 493_~pi~
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
Vice Pres