PERMFILE115200

• Permit No: M1989023
• IBM Index Class Name: Permit File
• Doc Date: 10/21/1988
• Doc Name: SPECIAL OPERATION 111 APPLICATION FORM
• Media Type: D
• Archive: No

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10. Correspondence Information
APPLICIINT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name:
Company Name: __ ~-~ ~ ,z ~ , ,.~ G ~p,v ~ ,.. ~ o
Street: {'~, d , fro ~ Z 1 81
city ~ F-_ ~o ~` ~ ,-~ s
State: C©Lo(inr,~p Zip Code: gpsZ2
Area Code: O 3 Telephone: _ 48 Z - 7854
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name: L,^IR~~G~ ~Nl.~ ~ sor-a ~(L ~\GF-1-Ll~ L-~~rEfZ
Company Name:
Street:
City:
State: Zip Code:
Area Cade: Telephone:
11. Primary future Cropland(CR) Pastureland(PL) _ General Agriculture(GA)
land use ~ Rangeland(RL) -_ Forestry(FR) Wildlife Habitat(WL)
(check ~ane): Residential(RS) Recreation (RC) ~ Industrial/Commercial(IC)
Developed Water T~esources(WR) _ Solid Waste Disposal(WD)
12. Primary present Cropland(CR) _ Pastureland(PL) _ General Agriculture(GA)
land use ~ Rangeland(RL) Forestry(FR) Wildlife Habitat(lJL)
(check one): Residential(RS) - Recreation (RC) - Industrial/Commercial(IC)
Developed Water l~sources(WR)
To the best of my knowledge, all the information pre ted on this pp ation form and
the attached Exhibits A-G are true and correct (mus b signed b applic /operator).
Date: -~L~o c3 G~2 14. lei 88 By: ~ ~ ~--~-
Grp s-/uF ~ ~ /'c1J ~'~ N
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