2004-06-18_PERMIT FILE - M2004037

• Permit No: M2004037
• IBM Index Class Name: Permit File
• Doc Date: 6/18/2004
• Doc Name: 110c Appl Pkt
• From: John M. Everitt
• To: DMG
• Media Type: D
• Archive: No

3-
14. Corresooodence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: John M. Everitt Tile: Owner
Comoanv Name:
Street/P.O. Box: 24274 County Road 17 P.O. $ox:
City:
State:
Telephone Number:
Fax Number:
Haxtun
Zip Code: 80731
~ 970 I-
( )-
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: SAME
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number: ( 1-
Fax Number: ( ) -
Zip Code:
CC: STATE OR FEDERAL LANDOWNER (if anvl
Agency: N/A
Stree[:
City:
State:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if
Agency: N / A
Street:
City:
Slate:
Telephone Number: ( 1-
P.O. Box:
Zip Code:
P.O. Box:
Zip Code:
Zip Code: