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3- <br />] 1. Corresoondeece Information: <br />APPLICANtlOPERATOR (name, address, and phone of name to be used on permit) <br />Contact's Name: L / 'r-y C~ f- C~/ ~Rd E C /Q[-'EK Title: <br />Company Name: ~ / 7Y o ~F ch' / PPt r cAE.(=~( <br />StreetfP.O.Box: 337 f-=. OERiyErT AVF/f/UE P.O.Box: ~3D <br />City: G Pi / dP~T t',,¢F/.~r <br />State: G U.t O R AD O Zip Code: ~ O ~/ 3 <br />Telephone Number: f u9 )) - ~ ,Qp - 2 SL7 2 <br />Fax Number: f '// `~ ) - ~ ~'~/ - 2 ~7 y <br />PERMITTING CONTACT (if different from applicant/operator above) <br />Contact's Name: f~ H 1 ~ N U FFA?Rti Title: ~ /RFG ; 0 R d f d UrS[/G i~vQ/4x5 <br />Company Name: C / T ~ 0 f C~ / PN / ~' C R.FEK <br />Sireet/P.O. Box: :2 b'/ C,,('~~ 9 P.O. Box: !~,'?D <br />City: C ~1 ~ PP~tE C FF_"/( <br />State: C O.C 0 R AD O Zip Code: ~O ~~ .3 <br />Telephone Number: ( 7/ 9 ) - / ~ 9 - :2 12,'i _ <br />Fax Number: ( `// 9 1- ~i ~% - D /.~{ <br />INSPECTION CONTACT <br />Con[act'sName: C/f/~ /~U~r"~jXJAj Title: D/RE'~TaR of~U !/r INn.4~ <br />Compaq Name: G / T ,Y a-F r ~R t !'~~ E G ~Plr ,Fi'C <br />Street/P.O. Box: 2 0 7 G~~~ P.O. Box: y 36 <br />city: c R / FP ~ ~ c ~P~'~.~ <br />State: !. (Z L,R /? // U Zip Code: A'O ~/,3 <br />Telephone Number: ( 7/ 9 ) - ,~iP 9- ? J~ 5- <br />Fax Number: ( 7/ 9 ) - / d'9 - o / X / <br />CC: STATE OR FEDERAL LANDOWNER (if anY1 <br />Agency: U.S~ FRr Df ~ti'rF i a /T U R FAU of ~ /JivO ~//ffi.¢6E.r~IiT <br />Street: 9,0 AoX .3// <br />City: C. ~.v©.v C /T Y <br />State: G d / 0 ~c' /a ®O Zip Code: r~/ :C / 2 <br />Telephone Number: ( '7/9 ) - ;Z 75 - ~ ~ 3 <br />CC: STATE OR FIDERAL LANDOWNER (if any) <br />Agency: <br />Street: <br />City: <br />State: <br />Zip Code: <br />Telephone Number: ( ) - <br />