PERMFILE107597

• Permit No: M1990144
• IBM Index Class Name: Permit File
• Doc Date: 2/8/1997
• Doc Name: REGULAR 112 PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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10. Correspond;~nce Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Indi~iidual's Name: John T. Ungefug
COmp~iny Name: Southway Construction Co., Inc
$trel't: 117 4Thite Pine Drive
City : Alamosa
State: Colorado Zip Code: 81101
Area Code: 719 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Indi~~idual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
Statia:
Area Code:
Telephone:
Zip Code:
11. Primary future Cropland(CR) Pastureland(PL) General Agriculture(GA)
land use g Rangeland(RL) - Forestry(FR) - Mildllfe Habitat(ML)
(check onel: Residential(RS) - Recreation(RC) - Industrial/Commerclal(IC)
Developed Mater l~sources(WR) _ Solid Waste Disposal(MD)
12. Primary present Cropland(CR) Pastureland(Pl) General Agriculture(GA)
land use z Rangeland(RL) -_ Forestry(FR) - Mildlife Habitat(ML)
(check one1: - Resldentlal(RS) Recreation(RC) - Industrial /Coamercial(IC)
Developed Water l~sources(WR)
To the best of ]b knowledge; all the information presented on this,appiication form and
the attached Exhibits A-P are true and correct (must be signed by ~ppli~ /operator).
<.i~,~