PERMFILE138033

• Permit No: M1989092
• IBM Index Class Name: Permit File
• Doc Date: 8/30/1989
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

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' 10. Correspondence Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
' Individual's Name: I]avia C~~rt~S
Company Name: Oaklanas R n h
' $tr•eet: lfil ~ Nnrth PPm park Road
Cit
y: co,~ai ; a
State: Colorado Zip Code: 80135
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
' Individual's Name: Ga„~,
Company Name:
' Strnet:
Ci t;i
' Stai:e: Zip Code:
A
C
d
T
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re~c
e:
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one:
INSPECTION CONTACT (if different from applicant/operator above)
' Individual's Name: Ga„n
ComF~any Name:
Street:
City:
' State: Zip Code:
Area Code: Telephone:
' 11. Primary future ® Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land us~~ ^ Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS)D Recreation(RC) ^ Industrial/Commercial(IC)
' D Developed Water Resources(WR) ^ Solid Waste Disposal(WD)
12. Primary pi^esent ^ Cropland(CR) ® Pastureland(PL) D General Agriculture(GA)
land use' D Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
' (check onel: ^ Residential(RS) ^ Recreation(RC) D Industrial/Commercial(IC)
^ Developed water Resources(WR)
' To the best of rqy knowledge, all the information present this application form and
the attach d Exhibits A-G are true and correct (must be sig ed by ap a /operator).

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