2004-05-11_REVISION - M1988022

• Permit No: M1988022
• IBM Index Class Name: Revision
• Doc Date: 5/11/2004
• Doc Name: Amendment Application
• From: Lincoln County
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

-3-
14. Correspondence Information:
APPLICANT/OPERATOR (mate, address, and phone of name to be used on perntit)
Contact's Name: Don Blake
Title:Land Use Adm.
Company Name: Lincoln County
Street/P.O. Box: 10 3 3rd Ave P.O. Box: 3 9
Cary: xuao
State: Colorado Zip Code: 80821
Telephone Nimtber: (719 )_ 7 4 3- 2 3 3 7
Fax Number: (719 ) - 7 4 3 - 2 815
PERMITTING CONTACT (if different from applicanUoperator above)
Contact's Name:
Company Name:
StreeUP.O. Box:
Ciry:
State:
Telephone Number: ( ) -
Fax Number: ( ) -
Contact's Name:
Compaq Name:
Street/P.O. Hox:
City:
State:
O. Box:
Zip Code:
Zip Code: 8 0 8 21
Telephone Number: ~] 19 )_ 7 4 3- 2 3 3 7
Fax Number: ( 719 )- 743-2815
CC' STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
Don Blake
Land Use Adm.
Lincoln County
103 3rd Ave P.O.Box: 39
Hugo
City:
State:
Telephone Number: ( ) -
Zip Code:
CC: STATE OR FEDERAL LANDOWNER (if an
Agency:
Stree[:
City:
State:
Zip Code:
Telephone Number: ( ) -