PERMFILE139105

• Permit No: M1990062
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT OPERATION 110 2 APPLICATION FORM
• Media Type: D
• Archive: No

~"~
~~
_~
-2- y
O
10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: CHA~I.~S T, I`~UNTZ- ROA-P FoR~/vl/+N
Company Name:
Street:
City:
State:
Area Code;
PERMITTING CONTACT
L°D~ 0 Zip Code: ~D
X03 Telephone: ~ ~6- 33 7
(if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State:
Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State:
Area Code;
Telephone:
Zip Code:
11. Primary future Cropland(CR) ~ Pastureland(PL) General AgricuTture(GA)
land use ` Rangeland(RL) Forestry(FR) i Wildlife Habitat(WL)
(check one): i Residential(RS) ' Recreation(RC) ~ Industrial /Comnercial(IC)
Developed Water ~sources(WR) _ Solid Waste Disposal(WD)
12. Primary present Cropland(CR) ~ Pastureland(PL) General Agriculture(GA)
land use - Rangeland(RL) Forestry (F R) - Wildlife Habitat(WL)
(check one): ~ Residential(RS) - Recreation(RC) Industrial/Comnercial(IC)
Developed Water Resources(WR)