2022-06-28_REVISION - M1985105 ‎(2)‎

• Permit No: M1985105
• IBM Index Class Name: Revision
• Doc Date: 6/28/2022
• Doc Name: Request For Conversion
• From: Lincoln County
• To: DRMS
• Type & Sequence: CN1
• Email Name: RAR
• Email Name: JLE
• Email Name: AWA
• Email Name: KME
• Media Type: D
• Archive: No

-3-
11. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: TY Sk)gsdil Title: Land Use Administrator
Company Name: Lincoln County
Street/P.O.Box: 103 Third Ave P.O.Box: 39
City: Hugo
State: CO Zip Code: 80821
Telephone Number: (719 )_ 743-2337
Fax Number: (719 )- 743-2815
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
Contact's Name: Same Title:
Company Name:
Street/P.O.Box: 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: ( )-
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( )-