PERMFILE120820

• Permit No: M1987078
• IBM Index Class Name: Permit File
• Doc Date: 5/5/1987
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

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10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: Mr. iiilliam C. Thrailkill
Company Name: City of Lamar, a Municival Coryoration
Street: 104 E. Parmenter P.O. Box 270
City : Lmar
State: Colorado Zip Code: 81052
^~~a Code: (3p3) Telephone: [phone]
PERIdITTiNG CONTACT (if different from applicant/operator above)
Lndividual's Name:
Company Name:
Street:
clty:
State:
Zip Code:
Area Code: Telephone:
INSPEC~fION CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
Si:ate
Area Code:
Telephone:
Zip Code:
{ 11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
_ - land use ^ Rangeland(RL) ^ Forestry(FR) d3 Wildlife Habitat(WL)
(check one): ^ Re sidential(RS)^•Recreation(RC) ^ Industrial/Commercial(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(lJL1
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR)
~`,~, T^ "•~ be~` "~ = .'~-.~:•ledy~, ,'.'. ":^ information presented on this application form and
the attached Exhibits A-G are true and correct (must be signed by applicant!^_~c-ct.:~;.
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~ Date: May 4, 1987 By: 1.~~_,QQ,_ L•-,~4~.4~s~
Public Works Director
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