2002-10-17_REVISION - M1978192

• Permit No: M1978192
• IBM Index Class Name: Revision
• Doc Date: 10/17/2002
• Doc Name: Application Form
• From: Chaffee County
• To: DMG
• Type & Sequence: CN1
• Media Type: D
• Archive: No

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14. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name; Jce Nelson Title: Road & Bridle Superintendent
Company Name: Chaffee Countv
Street:
104
City: Salida,
State: CO Zip Code: 81201
Telephone Number: ( 719 ) _ 539-4591 or { 719) - 539-h961
Pax Number: ( 719 ) , 539-7442
Contact's Name:
Company Name:
Street:
CT (if different from applicanUoperator above)
SAME Title:
City.
State:
Telephone Number: ( 1-_
Fax Number: ( ) -
INSPECTIONCONTACT
Contact's Name: SPP1E
Company Name:
Street
City.
State:
Telephone Number: ( ) -
Fax Number: ( ) -
CC~ STATE OR FEDERAL LANDOWNER (if anv)
Agency: N/A
Street
City.
State:
Telephone Number: L ) - _
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency: N/A
Street:
City:
State: _
Telephone Number:
Zip Code:
Tide:
Zip Code:
Zip Code:
Zip Code: