PERMFILE53767

• Permit No: M2003024
• IBM Index Class Name: Permit File
• Doc Date: 3/24/2003
• Doc Name: Permit Application
• From: Phillips County
• To: DMG
• Media Type: D
• Archive: No

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lA. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
ContacYsName: Randy Schafer ~ Title: Administrator/Planner
Company Name: Phillips County
StreetlP.O.Box: 221 S. Interocean Ave. P.O.Box:
City: Hnl vnke - "
State: co Zip Code: 80734
Telephone Number: ( 970 )- 854-3778
Fax Number: ( 970 )- 854-3811-
PERMITTING CONTACT (if different from applicant/operator above)
ContacYsName: Same as above .
Company Name:
StreeUP.O. Box:
City:
State:
Telephone Number:
Fax Number:
P.O. Box:
nacr>~ cTT~CONTPST .
ContacYsName: Same as above.
Company Name: _
Street/P.O. Box:
City:
State:
Telephone Number: ( ) -
Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any
Agcy,
Street:
City:
State:.
Telephone Number
Zip Code:
P.O. Box:
TsP
zip code:
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State:
Telephone Number
Zip Code: