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

• -z •
10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used o
Individual's Name: Dennis Ducommun
Company Name: Ducommun Business Trust
Street: P.O. Box 986. 460 N. Main
Ci ty: Alma
State: Colorado Zip Code: _
Area Code: 7~q Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: Dennis Ducommun
Company Name: 1]uc-ommun Ausiness Trust
Street: P.O. Box 986. 460 N. Main
City: Alma
State: Colorado Zip Code: _
Area Code: 719 Telephone: [phone]
INSPECTION CONTACT (if different from applicant/operator above)
permit)
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(WL)
(check one): Residential(RS) - Recreation(RC) - Indust 'al/Commercial(IC)
_ Developed Water T~esources(WR) _ Solid W ste Disposal(WD)
12. .Primary present Cropland(CR) Pastureland(PL) General Agriculture(GA)
land use g RangeTand(RL) - Forestry(FR) - Wildlif Habitat(WL)
(check one): Residential(RS) - Recreation(RC) -_ Indust 'al/Commercial(IC)
- Developed Water T~esources(WR)
To the best of my knowledge; all the information presented on this appl cation form and
the attached Exhibits A-P are true and correct (roust be signed by appli ant/operator).