2017-07-31_REVISION - M1991133

• Permit No: M1991133
• IBM Index Class Name: Revision
• Doc Date: 7/31/2017
• Doc Name: Application
• From: Robins Construction
• To: DRMS
• Type & Sequence: AM1
• Email Name: DMC
• Email Name: GRM
• Media Type: D
• Archive: No

3
1 1. Correspondence Information-
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name:
/ A -y yy Jt�,Otq Ir -IV S
Title: M,4v.a,�-/.v 1- �RTNE�
Company Name:
RoVfn/-c - G c.Al- 772ue_ T1 D N L L
T�
Street/P.O. Box;
3 67 E, 7 Hwy /7
P.O. Box:
City:
- _ . /V TG/V / T-0
State:
CGS --
Zip Code:=.
.f/ z 0
Telephone Number:
t 7/9 1- _ 376- z3.5 .1
Fax Number:
( 7/7 - 3 76 - 2 Z 3 /
PERM ITTI G CO T
(if different from applicant/operator above)
Contact's Name:
S�' p �'. ✓� h� 1fS Q !1/ _ T
Title:
; t:-:7-5 r '
Company Name:
T 1--W i<'Zr ` L-7 R- i JUIr
G f�
Street/P.O. Box:
3 l 7 S'— vc=/v
P.O. Box:
/997
City:
/ A-,4
State:
G 0
Zip Code:
9/
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name: _ , x O Y RG& 4/..i S. _ Title: /1'f4A,-4a -,AX-
Company
Company Name: t'B,Alm 6r1VS7-kCe-T1c+A! LLL
Street/P.O. Box: b' 7 b 7T2-A.ME j6�,qy /7 P.O. Box: 2
City: 10 Al TC,
State: C Zip Code. �'� / Z 0
Telephone Number: (7/
Fax Number: ( / - - �6-- . L_Z ;
CC: STATE OR FEDERAL LAh!DOWNER (if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: L
CC: STATE OR FEDERAL LANDOWNER if an
Agency:
Street:
City: _
State:
Telephone Number: L
Zip Code -
44Summit Engineering Job Number: 1707122CE 3
719-589-6147
AIamosa, CO