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TRI-STATE GENERATION AND TRANSMISSION ASSOCIATION, INC. <br />CROSSING LICENSE APPLICATION <br />1. <br />Applicant: I %,N A i ut' <br />Provide the legai name to appear on the Crossing and/ or Cost Agreement contract RIO <br />Address: 0 1 ?e a0? ('frI TCN <br />Phone: Cell Phone: <br />- Fax: _ - (o' ?` -- - - <br />2. If Applicant is a Business' Applicant's Authorized Agent: <br />3. Location of the Proposed Crossing: <br />Street Address: <br />bcri <br />?Rj 0-0_?_a?U_n ?Rc?ly <br />tate <br />Section , Township -, Range `t County 4& <br />Principle Meridian <br />Nearest Street or Road intersection: e Lc ?L-tCJ! `?? <br />4. Name Tri-State's Affected Facility and/or Structures: (e.g., transmission line, <br />substation, etc.) <br />5. Project description (describe in detail): (a) Type of facility, (e.g., pipeline, road); <br />(b) physical specifications (length, width, grading, etc.); (c) Impact on Tri-State's <br />affected facility and/or structures (such as grade change impacting conductor wire <br />clearance, proximity to a support structure, etc.)