2004-10-20_REVISION - M1978080

• Permit No: M1978080
• IBM Index Class Name: Revision
• Doc Date: 10/20/2004
• Doc Name: Amendment Application
• From: Lincoln County
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

3-
14. Corresoondeett Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Don Blake
Company Name: Lincoln County
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
Contact's Name:
Compatry Name:
Street/P.O. Box:
City:
State:
Telephone Ntunber:
Fax Number:
Land Use Adm
103 3rd Ave p_O.gox: 39
Hugo
C o Zip Code: 8 0 8 21
( 719 )- 743-
( 719 )- 743-
(if different from applicanUoperaror above)
P.O. Box:
Zip Code:
INSPECTION CONTACT
Contact's Name:
Company Name
Street/P.O. Box.
City:
Don Blake Title: Land Use Adm.
Lincoln County
P.O. Box:
State: Zip Code:
Telephone Number: ( 719 ~_ 7 4 3- 2 3 3 7
Fax Number: ( 719 ) - 7 4 3 - 2 815
CC: STATE OR FEDERA L LANDOWNER (if anv)
Agency:
Street:
City:
State: Zip Code:
Telephone Number
CC: STATE OR FEDERAL LANDOWNER (if an
Agency:
Street:
City:
State:
Zip Code:
Telephone Number L ~ -