2006-01-10_REVISION - M1979103 ‎(4)‎

• Permit No: M1979103
• IBM Index Class Name: Revision
• Doc Date: 1/10/2006
• Doc Name: Application
• From: Diana K Watson
• To: DMG
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-3-
1 I. Correanoodenm latormatbn:
APPLICANT/OPERATOR (name, address, and phone of name to be used on pettnit)
Contact's Name: niana u. w~anr, Title: Owner/Operator
Company Name:
S~eeUP.O. Box: 840 CR# 4 P.O. $ox: 105F,
City: MeeKer
State: (` n l n ra A n Zip Code: 816 41
Tetephone Number: (9 7 0 )- 8 7 8- 5 8 9 8
Fax Number: (970 )_ 878-4523
PERMITTING CONTACT (if different from applicanUopemtor above)
Contacts Name: Tite:
Company Name:
StreeUP.0. Box:
P.O. Box:
Ciry:
State: Zip Code:
Telephone Number: ( ) -
Fax Number; ( ) -
Contact's Name: Diana K- and lames L. WatsonTitle: Owner/opgrator ~ spouse
Comparty Name:
StreeUP,O.Box: 840 CR. #4 P.O.Box: P.0. Box 1056
City: Meeker
State: Colorado Zip Code: 81641
Tetephone Number: (9 7 0 )- 8 7 8- 5 8 9 8
Fax Number: { 970 )- 878-4523
CC: STATE OR FEDERAL LANDO WNER (if arry~
Agency:
Street:
City:
State:
Code:
Telephone Number: f ) -_
CC: STATE ORFEDERAI I.ANDOWNER(ifam)
Agency:
Street:
Citc:
State:
Telephotte Number: f ) -
Zip Cade:
i~g ~_