2014-08-11_REVISION - M1978078

• Permit No: M1978078
• IBM Index Class Name: Revision
• Doc Date: 8/11/2014
• Doc Name: Conversion Application
• From: Lincoln County
• To: DRMS
• Type & Sequence: CN1
• Email Name: TAK
• Email Name: AME
• Media Type: D
• Archive: No

11. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: JOHN DEWITT Title: LAND USE/OEM DIRECTOR
Company Name: LINCOLN COUNTY
Street/P.O.Box: 103 3rd AVENUE P.O.Box: 39
City: HUGO
State: COLORADO Zip Code: 80821
Telephone Number: (719 )_ 743-2337
Fax Number: (719 )_ 743-2815
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: SAME AS ABOVE Title:
Company Name:
Street/P.O.Box: P.O.Box:
City:
State: Zip Code:
Telephone Number: ( )Fax Number: ( )-
INSPECTION CONTACT
Contact's Name: JOHN DEWITT Title: LAND USE/OEM DIRECTOR
Company Name: LINCOLN COUNTY
Street(P.O.Box: 103 3rd AVE P.O.Box: 39
City: HUGO
State: COLORADO Zip Code: 80821
Telephone Number: (719 )_ 743-2337
Fax Number: (719 )_ 743-2815
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency: N/A
Street:
City:
State: Zip Code:
Telephone Number: ( 1-
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency: N/A
Street:
City:
State: Zip Code:
Telephone Number: ( )-