2016-11-09_REVISION - M1986140

• Permit No: M1986140
• IBM Index Class Name: Revision
• Doc Date: 11/9/2016
• Doc Name: Request for Conversion
• From: Merrill / Wright
• To: DRMS
• Type & Sequence: CN1
• Email Name: MAC
• Email Name: WHE
• Media Type: D
• Archive: No

-3-
11. Correspondence Information:
Tammie Crawford
APPLICANT/OPERATOR
(name, address, and phone of name ro be used on permit)
Park County
Contact's Name:
Tammie Cfawford
Title Transportation Mgr
Company Name;
Park County
Fairplay
Street/P.O. Box:
1246 CR 16
P.O. Bux- 147
City:
Fairplay
(719 _ 836-4283
State:
Colorado
Zip Code; 80440
Telephone Number:
1719 j - 836-4283
Fax Number:
C719 .836-4275
PERM177ING CONTACT
(if different from applicantloperator above)
Contact's Name:
_-_.-
Title:
Company Name:
Street/P.O, Box.
- — .. _ .— ............. ........
P.O. Box: _........
City:
_
State:
— .. ....... —
Zip Code: -
Telephone Number:
t . - . .....................
Fax Number:
L �} -
. .....-. .
INSPECTION CONTACT
Contact's Name:
Tammie Crawford
Title: Transportation Mgr
Company Name:
Park County
Street/P.O. Box:
1246CR16 _
P.O. Box: 147
City.
Fairplay
State:
Colorado
Zip Code: 80440_
Telephone Number:
(719 _ 836-4283
Fax Number:
( 719 } _ 836-4275
CC: STATE OR FEDERAL LANDOWNER {if an
A enc '
0 Y ---
Street.
City-
state: Zip Code:
Telephone Number: ( - —. --.--- --.. _ ..---.�
CC- STATE OR FEDERAL LANDOWNER (if any
Agency:
Street:
City: --
State: Zip Code:
Telephone Number... - --_