2017-01-17_REPORT - M1992074

• Permit No: M1992074
• IBM Index Class Name: Report
• Doc Date: 1/17/2017
• Doc Name: Annual Fee/Report Notice
• From: DRMS
• To: City of Colo Springs
• Annual Report Year: 2017
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

Page 5 of 5

Division records indicate the following permittee/landowner contact information (blank fields indicate that we do not have
information on record). If this information is blank or not current , please type or print current contact information:
Permittee Contact:

Patti Zietlow
Permittee Company:

City of Colorado Springs
Address:

P.O. Box 1103
Mail Code 940
Colorado Springs, CO 80947

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Philip C. Saletta
Company:

City of Colorado Springs Water
Dept.

Address:

30 S. Nevada Suite 603
Colorado Springs, CO 80903

Phone Number:

[phone]
Fax Number:
Email Address:
Inspection Contact:

Vern Finch
Company:

City of Colorado Springs Water
Dept.

Address:

404 W. Fontanero
Colorado Springs, CO 80907

Phone Number:

[phone]
Fax Number:
Email Address:

I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date

M-AF-04