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. ~. • • <~ <br />-2- <br />J110. Correspondance Information <br />~ ~ APPLICANT/OPERATOR (name, address, and phone of name to be used on permit) <br />Individual's Name: s~„i n; ~mar,t <br />Company Name: -aChelri:.,.i~"Pr r';nP!: r~„~-~any~ T.,~. <br />Street: v ~ ;;,,,, t,,~r <br />City: r „rat <br />State: Cp Zip Code: 81427 <br />Area Code: X03 Telephone: 925-4E,65 <br />PERMITTING CONTACT (if different from applicant/operator above) <br />Individual's Name: Carl I;ismant <br />Company Name: <br />Street: <br />c;ty: <br />State: Zip Code: <br />Area Code: Telephone: <br />INSPECTION CONTACT (if different from applicant/operator above) <br />Individual's Name: Carl Dismant <br />Company Name: <br />Street: <br />City: <br />State: Zip Code: <br />Area Code: Telephone: <br />11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA) <br />land use ^ Rangeland(RL) ^ Forestry(FR) Wildlife Habitat(WL) <br />(check one): ^ Residential(RS)^ Recreation(RC) ~ Industrial/Commercial(IC) <br />^ Developed Water Resources(WR) ^ Solid Waste Disposal(WD) <br />12. Primary present ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA) <br />land use p Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL) <br />(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC) <br />^ Developed Water Resources(WR) `:;ine <br />To the best of nU' knowledge, all the information presented'on this app ication form and <br />the attached Exhibits A-G are true and correct (must b~signe y ~ igant/operato <br />./ / <br />Date: 6/3o/P? By: ~ /~. <br />(~ '/O' pC~ owner <br />i e <br />