PERMFILE46188

• Permit No: M2006060
• IBM Index Class Name: Permit File
• Doc Date: 7/24/2006
• Doc Name: 112c application
• From: Jackson County Road and Bridge
• To: DMG
• Media Type: D
• Archive: No

3-
11 Corresyondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Comact's Name: Nelson Selcer Title: Su pervisor
Company Name: Jackson Countv Road and Brid ge
StreeUP.O.Bos: 188 Grant Street P.O.Box: 488
cin~: Walden
State: Colorado LipCode80480
'T'elephone Number: ( 970 1- 723-4481
Fax Number: f 970 )_ 723-8437
PL•RtvfITTING CONTACT (if dit£erent from applicant/operator above)
Contact's Name: Tide:

Company Name:

Street/P.O. Box: N.O. Box:

City:

State: Zip Code:

Telephone Number ( 1-

h'ax Ntunber: ( 1 -
[NSI'F.CTION CONTACT
contact's Name: Bureau of Land Management Title:
Company Name: '

Street/P.O.Box: 2103 East Park Avenue P.o.Box: 68
City: Kremmlina
state: Colorado Z;pCode: 80459

TelcphoneNumber: ( 970 ~_ 724-3437

Fax Numher: ( 1 -
CC: SPATE OR F1iDERA L LANDOWNER (if any)
Agency: Bureau of Land Management
Street: 2103 East Park Avenue
~;ty; Kremmling .
state: Colorado Lip Code: 80459

'fzlephone Number: ! 970 )~ 724-3437

CC: S'T'ATE OR FEDERAL LANDOWNER (if anv)
Agency:

Streee
CiR:
State: Zip Code:

Telephone Number ( 1-