PERMFILE120502

• Permit No: M1994007
• IBM Index Class Name: Permit File
• Doc Date: 2/9/1994
• Doc Name: LIMITED IMPACT OPERATION 110 2 APPLICATION FORM
• Media Type: D
• Archive: No

-2-
10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: phillios Countv Road Department
Company Name: phillios Countv
Street: 22I S. Interocean
City: Holyoke.
State: ('nlnradn Zip Code: 80734
Area Code: ~~q Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: Randy Schafer
Company Name: philliQa (nnnry
Street: 221 5. Interocean
City: Holvoke.
State: CO Zip Code: 80734
Area Code: 303 Telephone: [phone]
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name: Randy Schafer
Company Name: phillios County
Street: 221 S. Interocean
City: Holvoke
State: ~~ Zip Code: 80734
Area Code: 303 Telephone: [phone]
11. Primary future _ Cropland(CR) _ Pastureland(PL) General Aariculture(GA)
land use _ Rangeland(RL) _ Forestry(FR) ` Wildlife Habitat(WL)
(check one): Residential(RS) Recreation(RC) Industrial/Commercial(IC)
-_ Developed Water 1Zesources(WR) '_ Solid Waste Disposal(WD)
X Creekbed
12. Primary present _ Cropland(CR) _ Pastureland(PL) General Aariculture(GA)
land use _ Ranaeland(RL) _ Forestry(FR) ` Wildlife Habitat(WL)
(check one): _ Re sidential(RS) Recreation(RC) _` Industrial/Commercial(IC)
_ Developed Water ~sources(WR)
X Creekbed