2017-01-17_PERMIT FILE - M2016075

• Permit No: M2016075
• IBM Index Class Name: Permit File
• Doc Date: 1/17/2017
• Doc Name: Incompleteness Response
• From: Cheyenne County
• To: DRMS
• Email Name: TC1
• Media Type: D
• Archive: No

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It. Correspondence Information:
APPLICANT/OPERATOR
(name, address, and phone of name to be used on permit)
Contact's Name:
Marcy Brossman
Title: Administrator
Company Name:
Cheyenne County
Street/F.O. Box:
51 S. 1 st Street
P.O. Box: 567
City:
Cheyenne Wells
State:
Colorado
Zip Code: 80810
Telephone Number:719
1-767-5872
Fax Number:
719 1-767-5753
PERMITTING CONTACT
(if different from applicantloperator above)
Contact's Name:
Same as Applicant/Operator
Title:
Company Name:
Street/P.O. Box:
P.O. Box:
City:
State:
Zip Code:
Telephone Number:
f }
Fax Number:
f }
INSPECTION CONTACT
Contact's Name:
Same as Applicant/Operator
Title: .
Company Name:
Street/P.O. Box:
F.O. Box:
City:
State:
Zip Code -
Telephone Number:
FaxNumber:
............... -_......... .......................... ...- . .........-._.-_........................—.............-..............
--
CC: STATE OR FEDERAL LANDOWNER (if any
Agency:
Street:
city
State:...........—
Zip Coale:.._..... ........... - - -
Telephone Number:-
-.......... - _.-_......................
- —-...._-.........._-...
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Zip Code:
Telephone Number:
l 1- _---....._ ..... .....................__