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

• ~ -2- ~
10.
Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used
Individual's Name: Dennis Ducommun
Company Name: Ducommun Business Trust
Street: P.O. Box 986, 460 N. Main
City: Alma
State: _Colorado Zip Code:
Area Code: 7ia Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: Dennis Ducommun
COmpdny Ndrtle: nii _omm~in Aiiein ac T ie
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)
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
Zip Code:
Telephone:
permi t)
11. Primary future Lropland(CR) Pastureland(PL} _ General Agriculture(GA)
land use x Rangeland(RL) - Forestry(FR) Yildlif Habitat(WL)
(check one): - Residential(RS) - Recreation(RC) - Indust 'a1/Commercial(IC)
= Developed Water 1Fesources(MR) = Solid W ste Disposal(ND)
12. .Primary present Cropland(CR) Pastureland(PL) Genera~Agriculture(GA)
land use g RangeTand(RL) -_ Forestry(FR) - Ilildlif Habltat(WL)
(check one): Residential(RS) Recreation(RL) - Indust al/Conmercial(IC)
= Developed Water 1Fesources(WR) - ~
To the best of my knowiedge; ali the information presented ort this appl cation form and
the attached Exhibits A-Pare trv a and correct (must be signed by appli ant/operator).
C ~