PERMFILE103355

• Permit No: M1991071
• IBM Index Class Name: Permit File
• Doc Date: 6/24/1991
• Doc Name: APPLICATION WORKSHEET/CHECKLIST
• Media Type: D
• Archive: No

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10. Correspondence Infornatton
APPLICANT/OPERATOR (nape. address. and phone of nape to be used on permit)
Individual's Nape: Edgar Pratt ( Commissioner)
Cgnpdgy Nape: Kit Carson County
Street: PO Box 249, 251 16th St.
C1ty: Burline[on.
State!: Colorado Z1p Code: 80807-0249
Area Code: 71q Telephone: 346-s1s3
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
CotApany Name:
Street:
C1ty:
State: Zip Code:
Area Code: Telephone:
INSPEC'iION CONTACT (if different frog applicant/operator above)
Individual's Name:
C~~npagy Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
11, Primary fuwre Cropland(CR) _ Paswreland(PL) _ General Agriculwre(GA)
land use z Rangeland(RL) _ Forestry(FR) Wildlife Habitat(ML)
(check one): - Residential(RS) Recreation(RC) - Industrial/Cammercial(IC)
_ Developed Water lie sources(WR) _ Solid Waste Disposal(WD)
12. Primary present Cropland(CR) _ Pas w reland(PL) General Agricul w re(GA)
land use ~ Rangeland(RL) _ Forestry(FR) _- Wildlife Habitat(ML)
(check one): Residential(RS) Recreation(RC) Industrial/Commercial(IC}
_ Developed Water l~sources(WR) `