PERMFILE129465

• Permit No: M1986165
• IBM Index Class Name: Permit File
• Doc Date: 1/30/1987
• 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
Individual's Name: J ohn n;llnn
Company Name:
Street: ~, ~_ unY ~77~
City: Duraneo,
State: Colorario Zip Code: F
Area Code: 3~- Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: Same as above
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:
State:
Area Code:
Telephone:
Zip Code:
on permit)
11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ Genera Agriculture(GA)
land use ^ Rangeland(RL) ^ Forestry(FR) ^ Wildli a Habitat(WL)
(check one): ^ Residential(RS)^ Recreation(RC) ^ Indust ial/Commercial(IC)
^ Developed Water Re sources(WR) Q Solid aste Disposal(WD)
- othe SAND
12. Primary present ^ Cropland(CR) ^ Pastureland(PL) ^ Genera Agriculture(GA)
land use ^ Rangeland(RL) ^ Forestry(FR) ^ Wildli a Habitat(WL)
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Indust ial/Commercial(IC)
^ Developed Water Re sources(WR) X other SAND
To the best of my knowledge, all the information presented on this app ication form and
the attached Exhibit~sr A-G are true and correct (must be si ned by applicant/operator).
Date: ~--~ 'y U ~ By: