2018-03-23_PERMIT FILE - M2018012

• Permit No: M2018012
• IBM Index Class Name: Permit File
• Doc Date: 3/23/2018
• Doc Name: Application
• From: Jeff Carter
• To: DRMS
• Email Name: MAC
• Email Name: WHE
• Media Type: D
• Archive: No

288455 12/13/2017 02:57 PM B: 943 P: 283 LOC CT
Page 3 of 25 R $133.25 0 $0.00 T $133.25 Clear Creek
4. orr nd nce Information:
1111MKAUMMMIRWNI WN�iii
APPLICANTIOPE TOR (name, address, and phone of name to be used on permit)_
Contact's Name: jC-(X C Aec Title: Lr JS t {-
Company Name: _ Ss a - i Lwl) . I ruL _ _
Street: ) SLIASati i [ kms- 2K� P.O. Box
Citi: /m- a kX U 6A -%.L
State_ [ 10 0 p� Zip Code, 3Z —
Telephone Number � `� � - Z 3I — S5 11'1
Fax Number, 1
PERMITTING CONTACT (if different from applicant/operator above):
Contact's Name: Title:
Company Name:
Street:
P.O. Box:
City:
State.
Zip Code:
Telephone Number:Fax
Number: -
INSPECTION CONTACT:
Contact's Name:
Tale:
Company Name:
Street;
P.O. Box:
City,
State:
Zip Code:
Telephone Number:Fax
Number: -
CC: STATE OR FEDERAL LANPQWNER (if any):
Agency:
-
Street:
Citi -
State: .._
_ Zip Code:
Telephone Number:
CC: STATE OR FEDERAL LANDOWNER (if any).
Agency:
Street:
Cin
State:
Zip Code.
'telephone Number. i 1 -