REV97704

• Permit No: M1985029
• IBM Index Class Name: Revision
• Doc Date: 1/29/1990
• Doc Name: REGULARD 112 PERMIT APPLICATION FORM
• Type & Sequence: SO1
• Media Type: D
• Archive: No

• -_- • ~
10. Correspondance Information '
APPLICANT/OPERATOR (name, address, and phone of name to be used n permit)
Individual's Name: Dennis Ducommun
Company Name: Ducommun Business Trust
Street: P.O. Box N. Main
City: Alma
State: Colorado Zip Code:
Area Code: 7~q Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street: P.O. Box N. Main
City:
State: Colorado Zip Code:
Area Code: 719 Telephone: [phone]
INSPECTION 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 x Rangeland(RL) _- Forestry(FR) - Wildlif Habitat(lIL)
(check one): Residential(RS) Recreation(RC) - Indust al/Commercial(IC)
= Developed Water 1Fesources(WR) _ Solid W ste Disposal(41D)
12. .Primary present Cropland(CR) Pastureland(PL) _ Genera~Agriculture(GA)
land use g Rangeland(RL) - Forestry(FR) Hildlif Habitat(WL)
(check one): -Residential(RS) - Recreation(RC) - Indust al/Commercial(IC)
- Developed Water ~sources(WR) _
To the best of my knowledge; a1T the information presented on this appl cation form and
the attached Exhibits A-P are true and correct (must De signed by appli ant/operator).
Date: lice- ~~' /`j 9L By; - /~