REV103543

• Permit No: M1981006
• IBM Index Class Name: Revision
• Doc Date: 6/2/1988
• Doc Name: REGULAR 112 PERMIT APPLICATION FORM
• Type & Sequence: SO2
• Media Type: D
• Archive: No

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10. Correspondence Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: ctyriP R_ flarhart
Company Name: ('ant rat Annran~tac Tnr
Street: p_ (1_ Rns 9f,
City:
state: rnlnr~rin Zip Code: R1fiF(t
Area Code: ~~~ Telephone: fi~s_~~nn
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: same
Company Name:
Street:
City:
State:
Area Code:
INSPECTION CONTACT (if
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
Zip Code:
Telephone:
different from applicant/operator above)
Zip Code:
Telephone:
11. Primary future Cropland(CR) Pastureland(PL) General Agriculture(GA)
land use Rangeland(RL) Forestry(FR) Wildlife Habitat(WL)
(check one): Residential(RS) Recreation(RC) Industrial/Cammercial(IC)
Developed Water Resources(WR) Solid Waste Disposal(WD)
12. Primary present Cropland(CR) Pastureland(PL) General Agriculture(GA)
land use Rangeland(RL) Forestry(FR) Wildlife Habitat(WL)
(check one): Residential(RS) Recreation(RC) Industrial/Canmercial(IC)
Developed Water Resources(WR)
To the best of my knowledge, all the information presented on this application form and
the attached Exhibits A-P are true and correct (mus b si ned by Applican operator).
Date: Mav 20, 1988 BY: (~~Jl
P ident of Central A re ate Inc.
T t e