PERMFILE131981

• Permit No: M1987092
• IBM Index Class Name: Permit File
• Doc Date: 5/20/1987
• Doc Name: 110 APPLICATION
• Media Type: D
• Archive: No

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J0. Correspondance Information
APPLICP•NT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: Jordan C. or Jone L. Burdick
Company Name: B and G Stone
Street: P.0. Box 1385
City: Lyons
State: n~i~r„~~ Zip Code: Hos4o
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Inidividual's Name:
Company Name:
Street:
City:
State:
Zip Code:
Arra Code: Telephone:
INSPECT;'ON CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
11. Primary future ^ Cropland(CR) ~] Pastureland(PL) ^ General Agriculture(GA)
land use ^ 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 ^ Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR)
To the best of my knowledge, all the information presented on this application form and
the att'a~c/h/~Jed Exhibits A-G are true and correct (must be signed by a/pp~licant//operator).
Date : ~ O _~ / 9~7 BY ~ _ ~ ~ PV.,~~i~C, -
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