REV04073

• Permit No: M1978225L
• IBM Index Class Name: Revision
• Doc Date: 6/18/2001
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

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14. Correaoondence Information:
APPLLCANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: TROY CRANE Title: BACA COUNTY COhAtISSIONER
Company Name: BACA COUNTY
Street: 741 MAIN STREET
City: SPRINGFIELD
State: COLORADO Zip Code: 81073
Telephone Number: 7t 19 1.523-6532
Fax Number: 7( 19 1- 523-6584
PERMITTING CONTACT (if different from applicaat/operator above)
CoatacYsName: SAME Title:
Company Name:
Street:
City:
Stater
Telephone Number:
Fax Number:
INSPECTION CONTACT
Zip Code:
Contact's Name: Title:
Company Name:
Street:
c;ry:
State: Zip Cade:
Telephone Number: ~_] -
Fax Number: ~~ -
CC: STATE OR FEDERAL LANDOWNER fif any]
Agency:
Street:
City:.
Slate: Zip Code:
Telephone Number: ~_1-
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street
City:
Stale: _ Zip Code:
Telephone Nttmber