2015-12-08_REVISION - M1979059

• Permit No: M1979059
• IBM Index Class Name: REVISION
• Doc Date: 12/8/2015
• Doc Name: Application AM03
• From: DRMS
• To: Coulson Excavating Company, Inc.
• Type & Sequence: AM3
• Email Name: MAC
• Media Type: D
• Archive: No

I I. Correspondence Information.
APPLICANT/OPERATOR (name. address, and phone of name to be used on permit)
Ken Coulson
Contact's Name.
Company Name.
Street/P 0. Box:
City:
State:
Telephone Number:
Fax Number:
PERMI'ITING CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number.
Fax Numbei.
Coulson Excavating Company, inc.
Title: President
1309 N. County Rd 13
Loveland
P.O. Box:
Colorado
Zip Code: 80538
970 )_ 667-2178
( 970 )_ 667-2193
(if different from applicant/operatot above)
Peter Wayland
Weiland, Inc.
•ritie: President
Boulder
P.O. Box: 18087
Colorado
Zip Code: 80308
( 303 ) _ 443-9521
Ken Coulson
Coulson Excavating Company, Inc.
3609 N. County Rd 13
Title: President
Loveland
P.O. Box:
Colorado
Zip Code: 80538
970 )_ 667-2178
( 970 ). 667-2193
CC. STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Zip Code.
Telephone Number: I ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Telephone Number.
Zip Code: