2019-12-06_REVISION - M1978080

• Permit No: M1978080
• IBM Index Class Name: Revision
• Doc Date: 12/6/2019
• Doc Name: Request for Conversion of Permit
• From: Lincoln County
• To: DRMS
• Email Name: JPL
• Email Name: JLE
• Email Name: AWA
• Media Type: D
• Archive: No

-3-
11. Corresvondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit) ''
Contact's Name: y2 Lund Title:Lcung Use Nj rn;n i SLra iy rr
Company Name:
Street/P.O.Box: 3 r c� �.�C� P.O.Box: 3�
City:
State: C Zip Code:
Telephone Number: ( �I\R 1- 1-7
Fax Number: ( 11Q )- -1 y 3 -aq .s
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Title:
Company Name:
Street/P.O.Box: P.O.Box:
City:
State: Zip Code:
Telephone Number: (Fax Number: ( -
INSPECTION CONTACT r 1
Contact's Name: Ir r re-A L Title:Land
Company Name: L-�.c r��" C� f.�►
Street/P.O.Box: 11 11 Co 3 - r4 AV P P.O.Box: 3�-
City: k-t µ n
State: C_D Zip Code: P30821
Telephone Number: ( -1 1 R )- -1 4 3 -1-3!)M
Fax Number: -11 - -1 L4 3 81 S
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( )-
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( -