2019-11-20_PERMIT FILE - M2019057

• Permit No: M2019057
• IBM Index Class Name: PERMIT FILE
• Doc Date: 11/20/2019
• Doc Name: Application
• From: Jacom Ulrich
• To: DRMS
• Email Name: ERR
• Email Name: JDM
• Email Name: AWA
• Media Type: D
• Archive: No

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9. Correspondence Information:
APPLICANT/OPERATOR(name,address,and phone of name to be used on permit):
Contact's Name: Jacob Ulrich Title: claim owner and operator
Company Name: n/a
Street: 17619 Leisure Lake Dr P.O. Box:
City: Monument
State: Colorado Zip Code: 80132
Telephone Number: (303 ) - 328-8726
Fax Number: ( ) -
PERMITTING CONTACT(if different from applicant/operator above):
Contact's Name: same as above Title:
Company Name:
Street: P.O.Box:
City:
State: Zip Code:
Telephone Number: ( ) -
Fax Number: ( 1 -
INSPECTION CONTACT:
Contact's Name: Brent Rovedo Title: claim owner and operator
Company Name: n/a
Street: 18049 E Bellewood Dr P.O.Box:
City: Aurora
State: CO Zip Code: 80015
Telephone Number: (303 ) - 396-7073
Fax Number: ( 1 -
CC: STATE OR FEDERAL LANDOWNER(if any):
Agency: South Park Ranger District
Street: 320 Highway 285
City: Fairplay
State: Colorado Zip Code: 80440
Telephone Number: (719-836- -
CC: STATE OR FEDERAL LANDOWNER(if any):
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) -