2013-12-20_PERMIT FILE - M1990116

• Permit No: M1990116
• IBM Index Class Name: PERMIT FILE
• Doc Date: 12/20/2013
• Doc Name: 112 Application CN01
• From: Phillips County Road & Bridge
• To: DRMS
• Type & Sequence: CN1
• Email Name: ECS
• 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 SCHAFER
Title: ADMINISTRATOR /PLANNER
Company Name:
PHILLIPS COUNTY
Street/P.O. Box:
221 S INTEROCEAN AVE
P.O. Box:
City:
HOLYOKE
State:
CO
Zip Code: 80734
Telephone Number:
( 970 1-854-3778
Fax Number:
( 970 ) _ 854 -3811
PERMITTING CONTACT
(if different from applicant/operator above)
Contact's Name:
Title:
Company Name:
Street/P.O. Box:
P.O. Box:
City:
State:
Zip Code:
Telephone Number:
( )
Fax Number:
( ) -
INSPECTION CONTACT
Contact's Name:
RANDY SCHAFER
Title: ADMINISTRATOR /PLANNER
Company Name:
PHILLIPS COUNTY
Street/P.O. Box:
221 S INTEROCEAN AVE
P.O. Box:
City:
HOLYOKE
State:
CO
Zip Code: 80734
Telephone Number:
( 970 ) _ 854 -3778
Fax Number:
( 970 ) _ 854 -3811
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Zip Code:
Telephone Number:
( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Zip Code:
Telephone Number:
( ) -