2017-09-13_REVISION - M1978051

• Permit No: M1978051
• IBM Index Class Name: Revision
• Doc Date: 9/13/2017
• Doc Name Note: for Conversion
• Doc Name: Application
• From: Lincoln County
• To: DRMS
• Type & Sequence: CN1
• Email Name: TC1
• Email Name: WHE
• Media Type: D
• Archive: No

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ll. Correspondence -Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Trey James Title: Land Use Administrator
Company Name: Lincoln County
StreetIP.O. Box:
City:
State:
103 3rd Avenue P.O. Box: 39
Hugo
Colorado Zip Code: 80821
Telephone Number: ( 719„ „ - . 1-743-2337
Fax Number. ( 719 ) _ 743-2815
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
StreetIP.O. Box:
City:
Title:
P.O. Box:
Zip Code:
Trey James Title: Land Use Administrator
Lincoln County
103 3rd Avenue
Hugo
P.O. Box: 39
State: Colorado Zip Code: 80821
Telephone Number: ( 719 1-743-2337
Fax Number: ( 719 ) _ 743-2815
SATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Telephone Number: ( 1 -
CC: STATE OR FEDERAL LANDOWNER (ifanyj
Agency:
Street:
City:
State:
Telephone Number.
Zip Code:
Zip Code: