PERMFILE134681

• Permit No: M1987044
• IBM Index Class Name: Permit File
• Doc Date: 3/24/1987
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

_ - .:y..
~- ~~
-2-
10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: John Dillon
Company Name: 5andco
Street: P. 0. Box 1773
Gi ty : Duraneo
State: Colorado ~ Zip Code: A13~~
Area Code: 303 Telephone: 247-1'i0'i
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: Same as above
Company Name:
Street:
City:
State:
Area Code:
Telephone:
Zip Code:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name
Company Name:
Street:
City:
State:
Area Code:
Telephone:
Zip Code:
11. Primary future
land use
(check one):
12. Primary present
land use
Ccheck one):
^ CroplandiCR) ^ PasturelandfPL)
^ Rangeland(RL) ^ Forestry(FR)
^ Residential(RS)^ Recreation(RC)
^ Developed Water Resources(WR)
^ Cropland(CR) C; Pastureland(PL)
^ Rangeland(RL) ^ Forestry(FR)
^ Residential(RS) ^ Recreation(RC)
^ Developed Water Resources(WR)
^ General Agriculture(GA)
^ Wildlife Habitat(WL)
^ Industrial/Commercial(IC)
^ Solid Waste Disposal(WD)
^ General Agriculture(GA)
^ Wildlife Habitat(WL)
® Industrial /Commercial(IC)
To the best of my knowledge, all the information presented on this application form and
the attached Exhibitns A-G are true and correct (must be signed by applicant/operator).
Date: T~ilctyi~l /7 /987 BY:
r e