PERMFILE41041

• Permit No: M2002017
• IBM Index Class Name: Permit File
• Doc Date: 4/10/2002
• Doc Name: Substitute Application Page # 3
• From: Lincoln County
• To: DMG
• Media Type: D
• Archive: No

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14.
Correspondence Information:
APPLICANTlOPERATOR (name, address, and phone of name to be used on pemilt)
Contact's Name: DON BLAKE Title: LAND U5E ADMIN
Company Name: LINCOLN COUNTY
Street: 10 3 3rd S t P. 0. 3 9
City: HUGO
State: COLO.
Telephone Number: (_ 719 )- 7 4 3- 2 3 3 7
Fax Number: f 7191- 743-2815
PERMITTING CONTACT (if different firom applicant(operator above)
Contact's Name: Title:
Company Name:
Street:
City:
S[ate:~
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Sheet:
Zip Code: 8 0 8 21
Zip Code:
Don Blake Title: Land Use Admin
Lincoln County
City:
State:
Telephone Number: (,~ -
Fax Number: ~~ -
CC: STATE OR FEDERAL LANDOWNER /if anv)
Agency:
Street:
City:
State:
Telephone Number: ~~ -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Zip Code:
Zip Code:
Zip Code:
Telephone Number: ~~ -