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2/21/25,4:07 PM ePermitting Signup for New Applications and Annual Reporting <br /> Street Address: <br /> P.O. Box 551 <br /> ....... ....................................................................................................................................... <br /> City. <br /> Keenesburg <br /> _............................................................................................................................................................................ <br /> State: * <br /> Colorado <br /> _............................................................................................................................................................................ <br /> Zip: <br /> 80643 <br /> _............................................................................................................................................................................ <br /> Telephone: <br /> 307-331-9156 <br /> ..............I .......................................................................................................................................................... <br /> Currently held Permit/N01 Numbers (ie M1987189, P2016026) <br /> M1982287 <br /> _...................................................................._.................................................................................. <br /> Last Name of individual who will act as account administrator for the ePermitting account: <br /> Arnusch <br /> _............................................................................................................................................................................ <br /> https://docs.google.com/forms/d/1 IrxOW3YTBhUgGtgfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNikUGUhkgG7v8AnFjYOTruHfy645rd... 2/4 <br />