2015-07-07_REVISION - M2013084

• Permit No: M2013084
• IBM Index Class Name: REVISION
• Doc Date: 7/7/2015
• Doc Name: Application AM01
• From: Phillips County
• To: DRMS
• Type & Sequence: AM1
• Email Name: ERR
• Email Name: WHE
• 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 _ 854-3778, Cell 970-520-0502
Fax Number: ( 970 _ 854-3811
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: same Title:
Company Name:
Street/P.O. Box: P.O. Box:
Citv:
State: Zip Code:
Telephone Number: ( ) Fax Number: ( ) -
INSPECTION CONTACT
Contact's Name: same Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( ) Fax Number: ( ) -
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: ( ) -