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REV95975
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REV95975
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Entry Properties
Last modified
8/25/2016 3:20:49 AM
Creation date
11/21/2007 11:54:12 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1977057
IBM Index Class Name
Revision
Doc Date
10/14/1988
Doc Name
LIMITED IMPACT OPERATION APPLICATION FORM
Type & Sequence
SO1
Media Type
D
Archive
No
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~ • • • <br />-2 <br />10. Correspondence Information <br />APPLICANT/OPERATOR (name, address;~and phone of name to be used on permit) <br />Individual's Name: Charles Leon F'Qdinec <br />' Company Name: <br />Street: 3431 County Rd. 120 <br />City: Craig <br />State: Colorado Zip Code: $1625 <br />Area Code: 303 Telephone: 824-6759 <br />PERMITTING CONTACT (if different from applicant/operator above) <br />Individual's Name: Same as above <br />~, Company Name: <br />Street: <br />' City: <br />State: Zip Code: <br />Area Code: Telephone: <br />' INSPECTION CONTACT (if different from applicantloperator above) <br />IndiVldUa1's Name: Same as above <br />~ Company Name: <br />' Street: <br />City: <br />State: Zip Code: <br />Area Code: Telephone: <br />li 11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA) <br />land use ® Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WU <br />(check one): ^ Residential(RS)^ Recreation(RC) ^ Industrial/Commercial(IC) <br />~ D Developed Water Resources(WR) ^ Solid Waste Disposal(WD) <br />i 12. Primary present ^ Cropland(CR) D Pastureland(PL) ^ General Agriculture(GA) <br />land use ® Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL) <br />(check one): O Residential(RS) ^ Recreation(RC) ^ Industrial/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-G are true and correct (must//~~be igned by appl' ant/op ator). _ <br />Dater ~~3~ ~ gy;~(i~k~~c~~~ o ~,... a.. <br />Charles Leon Fedinec <br />i e <br />
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