PERMFILE57538

• Permit No: M2004001
• IBM Index Class Name: Permit File
• Doc Date: 1/5/2004
• Doc Name: Application
• From: Lincoln County
• To: DMG
• Media Type: D
• Archive: No

-3-
14. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Don Blake Title: Land Us2eAdm
Campan}'Name: Lincoln County
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
103 3 rd Ave
P.O. Box:
Colorado Zip Code: 80821
( 719 )- 743-2337
( 7198 )- 743-2815
PERMITTING CONTACT (if different from applicant/operator above)
Contact's I~`ame:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Sheet/P.O. Box:
P.O. Box:
Zip Code:
Don Blake
Title: Land Use Adm.
Lincoln County
103 3rd Ave P.O.Box: 39
City: Huao
State: Colorado Zip Code: 8 0 8 21
Telephone Number: ( 719 )- 7 4 3- 2 3 3 7
Fax Number: ( 719 )- 743-2815
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Telephone Number: ( ) -
Zip Code:
CC' STATE OR FEDERAL LANDOWNER (if and
Agency:
Sheet:
Ciry:
State: Zip Code:
Telephone Number: ( ) -