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- 3 - <br />19. Correanondence Information: <br />APPLICANT/OPERATOR (name, address, and phone of name to be used on permit) <br />Contact's Name: RICK DYKSTRA Title: COMMISSIONER <br />Company Name; KIT CARSON COUNTY DISTRICT #3 <br />Street: PO BOX 160 <br />City: BURLINGTON <br />State: COLORADO Zip Code: 80807 <br />Telephone Number: ( 719 ) - 396-8139 <br />Fax Number: ( 719 ) - 396-7292 <br />PERMITTING CONTACT (if different from applicant/operator above) <br />Individual's Name: Title: <br />Company Name: <br />Street: <br />City: <br />State: Zip Code: <br />Telephone Number: <br />Fax Number: <br />INSPECTION CONTACT <br />Individual's Name: <br />Company Name: <br />Street: <br />City: <br />State: <br />LYNDA BROWNFIELD, COUNTY ADMINISTRATOR <br />KIT CARSON COUNTY <br />Po BOX 160 <br />BURLINGTON <br />CO Zip Code: 80807 <br />Telephone Number: ( 719 ) - 346-5940 <br />Fax Number: ( 719 ) - 396-7292 <br />CC: STATE OR FEDERAL LANDOWNER (if any) <br />Agency: <br />NOTES RECEIPT DATE / - /0 5~ <br />~~- 5484 <br />RECEIVED FROM ~~ ~ C ti 1 S a -. C D ~.. -~ <br />ADDRESS <br />J <br />FOR i l l % 0 •_U b O <br />eASN <br />..~ ~ l'.MEf.K <br />O NONEV <br />ORDEq <br />~7S- ~ e ( <br />Z/~~yb Y~ / <br />BV S/. ~ i, <br />o~as~ R®IFq+M® e~s~s <br />