2013-12-20_PERMIT FILE - M2013084

• Permit No: M2013084
• IBM Index Class Name: PERMIT FILE
• Doc Date: 12/20/2013
• Doc Name: New Application
• From: Phillips County
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

-3-
11. Correspondence Information:
APPLICANT /OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Randy Schaffer
Company Name: Phillips County
Street/P.O. Box: 221 S. Interocean Ave.
City: Holyoke
State: CO
Telephone Number: ( 970 _ 854 -3778, Cell 970- 520 -0502
Fax Number: ( 970 _ 854 -3811
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: same
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number: ( ) Fax Number: ( ) -
INSPECTION CONTACT
Contact's Name: same
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number: ( ) Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any
Agency:
Street:
City:
State:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Telephone Number:
Title: Administrator /Planner
P.O. Box:
Zip Code: 80734
Title:
P.O. Box:
Zip Code:
Title:
P.O. Box:
Zip Code:
Zip Code:
Zip Code: