REV13706

• Permit No: M1978249
• IBM Index Class Name: Revision
• Doc Date: 10/25/2001
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

_a.

14. Corresoondevm Information:
APPLICANT/OPERATOR (name. address, and phone of name to be used oo permit)
Contact's Name: Ken Strohson Title: County Planner
Company Name: Loan County
Street: 315 Main Street
City: Sterling
State: ~O Zip Code: 80751
Telephone Numlf'er: ( 970 - 5'L'L-UIIiIIi )
Fax Number: ( g7n 1- 522-4018
PERMITTING CONTACT (if different from applicanUoperator abo.•e)
Contact's Name: Ken Strohson
Company Name: Same as above
Street:
City:
State.'
County Planner
Zip Code:
Telephone Number: ~~ -
Fex Number: L-~ -
INSPECTION CONTACT
Contact's Name:
Company Name: ,
Sheet
Citv:
State:
Telephone Number: L-~ -
Fax Number: (__1-
CC: STATE OR FEDERAL. LANDOWNER (if any]
Agency:
Street:
City:
State:
Ken Strettson Title: County Planner
Telephone Number: ~~ -
CC: STATE OR FEDERAL LANDOWNER (if any]
Agency:
Street:
Cit}':
State:
Telephone Number: ( -
Zip Cade:
Zip Code:
Zip Code: