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I <br />NAMES AND ADDRESSES OF ADJOINaJCa PROPERTY OWNF3tS, IFSSEES, ETC., WHOSE PROPERTY ALSO ADJOWS THE WATEAWAY <br />MacPhee Family Trust Della M. Fellia Marcine & Nita Lou Webb Allen J. & Cheryl Walz <br />I,; Mary Salustro sox 543 1136 HWY 23 18473 US HWY 550 <br />('.0. Box 431 Ouray, CO 81427 Ridgway, CO 81432 Ridgway, CO 81432 <br />dultham, MA 02254 <br />~hn C. & Tracy Imhoff sad Matthew Willard <br />Violet Court <br />Ridgway, CO 81432 <br />i WATERBODY AND LOCATION ON WATERBODY WHERE ACTIVITY EXISTS OR IS PROPOSED <br />]ncompahgre River, East of CR 23, just North of Idlewild subdivision, app, 5 mi North of Ouray <br />7 LOCATION ON lANO WHERE AC'nVITY D(ISTS OR IS PROPOSED <br />ADDRESS: County Road 23 <br />Ouray County, CO 81427 <br />STREET, gOA/D, ROUTE OR OTHER DESCRIPTIVE LOCATION <br />Ouray Colorado 81427 <br />COUNTY STATE ZIP CODE <br />Ouray County Commissioners <br />LOCAL GOVERNING BODY WITH JURISDICTION OVERBITE <br />I Is any portion ul the activity Ia which euthatzallon is sought now complelel ~ YES U NO <br />II answer Is 'yes' plus reasons, month eM year the aclinry was completed. kldirale the adslinp work an the drawings. <br />LI91 all applovel! 01 Cer1111C8I1ef1! end denlaLS reL01VBd from Olhar lederel, lnlar9lab, stale or lofdl agenCle! for any atnlClUlel. oOnsIIUCl1011. dISCllergea or other <br />Br:1lVllle9 desGllled In Ih19 apphcalion. <br />ISSUING AGENCY TYPE APPROVAL IDEMIFICATION NO. DATE OF APPLICATION DATE OF APPROVAL DATE OF DENIAL <br />Ouray County Special IIse Permit 12-16-91 <br />State of Colorado <br />Mined Land Reclamation Board <br />Limited Impact Permit 12-16-91 <br />0 Application is hereby made for a permit or permll! to eulhorire the ectivitias daaralhed herein. I tertity that 1 rNl lamilw with the mtormetion contained m the <br />epplicallon, end that to the Dent M my knowledge end ballet such mlormetion U true, complete, and eaurete. I lurlher cerlity Thal I posaels the authonry to <br />undertake the proposed aCtivi11e1 a I run acting o9 the OuN auNwized agent of the applicant. <br />SIGNATURE OF APPLICA ~ DATE SIGNATURE OF AGFIJT DATE <br />k ~l Ur s'~ ~ ~r-ve [a0 <br />I- /~' YZ, /-/~-9z <br />The applrce6on must be signed Dy fhe person who desires fo undeneke Ire proposed acliviry (applicant) or if maybe signed by a duly <br />authorizetl spent it the statement in block 3 has been fi)letl out and signed. <br />t 8 U.S.C. Section 1001 provides 71st Wtwever, N any rtlanrtar within 71e jurisdiction of any doparlntent w aOerwY of The Ultiled States <br />kndwrrlgly and Wlgtllay falsifies, cnrtceats, W Covers up by arty IriCk, 19C11afr16, O/ 118VICe a nla0enal fact a nl8kae any lake, 11Ch11g19 Or IreudUlBM <br />statements a repreeanl8lgna ix makes a uses any false writing d document krlavirp same b omtain anY IaLsa lictrtioua a <br />~ freldulBrit statement Dr entry, shall be [sled not ttYJre 71an 510,000 W vnp+isoned rot more 71art flue years, a both. <br />•Y d Erq rWNY qsa) 'U.s. Gw.arrurwm Prhllnp Olnu: 1 W 1 - 3Y9-I74ro901 <br />