PERMFILE134694

• Permit No: M1987143
• IBM Index Class Name: Permit File
• Doc Date: 9/1/1987
• 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: M.R. Gydesen
Company Name: Joel Fennern & M.R. Gydesen Heavy Equip. Co.
Street: Box 294
City: Gunnison
State: Colorado Zip Code: 81230
Area Code: 303) Telephone: [phone]
PERFIITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State:
Individual's Name:
Company Flame:
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 Re 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): ^ Residential(RS) ^ Recreation(RC) L~ Industrial /Commercial(IC)
^ Developed Water Re sources(WR)
' To the best of my knowledge, all the information presented on this application form and
the attached Exhibits A-G are true and correct (m-u~st, b,~e signed by applicant/operator).
Date: ~~~- ~p~~~ BY~~//~e.l~--
' it e ~
Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from applicant/operator above)