PERMFILE129580

• Permit No: M1992007
• IBM Index Class Name: Permit File
• Doc Date: 2/3/1992
• Doc Name: LIMITED IMPACT OPERATION 110 2 APPLICATION FORM
• Media Type: D
• Archive: No

l~ -2-
10. Correspondence Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: uJg22~ T ~o~E2
Company Name:
Street:
City: L1 rZa+y
State: ~.o try Zip Code: ~ ~ (, z G
Area Code: ~3_ Telephone: g'LS~ - 3i i~
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: 1`-'1n.2~/„J iV~~n2~C. •
Company Name:
Street:
City:
Sta te:
Area Code:
INSPECTION CONTACT (if
Individual's Name:
Company Name:
Street:
City:
State:
1~•n fox liL ~1
(? (2,c~t C.
~,~L,-~ Zip Code: + (0 2to
e.t
3~_Telephone: rdZ~--92~~ c°~z~-3~+t~
different from applicant/operator above)
M~a2~~ ~ Moo2~
Zip Code:
Area Code:
Telephone:
11. Primary future Cropland(CR) _ Pastureland(PL) _ General Agricutture(GA)
land use /Rangeland(RL) _ Forestry(FR) _ Wilo'ife Habitat(WL)
(check one): - Residential(RS) Recreation(RC) Industrial/Commercial(IC)
_ Developed Water ~sources(WR) ~ Solid Waste Disposal(WD)
12. Primary present Cropland{CR) _ Pastureland(PL) General Agriculture(GA)
land use /Rangeland(RL) _ Forestry(FR) ~_ Wildlife Habitat(WL)
(check one): - ResidentialiRS) Recreation(RC) _ Industrial/Commercial(IC)
_ Developed Water l~sources(WR)