2021-06-23_REVISION - M1977300

• Permit No: M1977300
• IBM Index Class Name: REVISION
• Doc Date: 6/23/2021
• Doc Name Note: *NO PAYMENT INCLUDED*
• Doc Name: Request For Amendment To Permit
• From: Colorado Legacy Land
• To: DRMS
• Type & Sequence: AM6
• Email Name: AME
• Email Name: MAC
• Media Type: D
• Archive: No

4-
Correspondence Information:
APPLICANT/OPERATOR(name,address,and phone of name to be used on permit):
Contact's Name: Jim Harrington Title: Managing Partner
Company Name: Colorado Legacy Land
Street: 12150 E. Briarwood Ave. Suite 135 P.O. Box:
City. Centennial
State: Colorado Zip Code: 80112
Telephone Number: ( 970 1 _ 632-2239
Fax Number: 1 L -
PERMITTING CONTACT (if different from applicant/operator above):
Contact's Name: Title:
Company Name:
Street: P.O.Box:
City:
State: Zip Code:
Telephone Number: ( 1 Fax Number: ( 1 -
INSPECTION CONTACT:
Contact's Name: Title:
Company Name:
Street: P.O.Box:
City:
State: Zip Code:
Telephone Number: ( )Fax Number: ) -
CC: STATE OR FEDERAL LANDOWNER if any):
Agency:
Street:
City:
State: Zip Code:
Telephone Number: 1 ) -
CC: STATE OR FEDERAL LANDOWNER(if any):
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) -