PERMFILE124198

• Permit No: M1987103
• IBM Index Class Name: Permit File
• Doc Date: 6/10/1987
• 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: Iuilor a~. ::ins
Company Name: ~• Sim© Oravel Co.
:Street: P,cx 51

:itate: Colorado Zip Code: 81648
Urea Code: ;~~~•. Telephone: 675x2306
PERMITTING CONTACT (if different from applicant/operator above)
:Individual's Name: sarr.
(:ompany Name:
Street:
r;; ty:
:Mate: Zip Code:
Urea Code: Telephone:
INSPECTION CONTACT (if different from applicant/operator above)
]'ndividual's Na me: S:,}.?.
(:ompany Name:
~~treet:
c;ty:
State: Zip Code:
p,rea Code: Telephone:
11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use U Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(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 p Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(iJL)
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR)
To the best of my knowled ge, all the information presented on this application form and
the attached Exhibits A-G are true and correct (must be signed by applic
ant/operator).
Date: ,iii r,. ~~ i~r~ ~
BY: ~~_e~ ~'+..~ ,~Clci~.~r~
it e