REV88413

• Permit No: M1994118
• IBM Index Class Name: Revision
• Doc Date: 10/16/2003
• Doc Name: Application
• From: Fremont County
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

-3-
14. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name [o be used on permit)
Contact's Name: ~-iN
Company Name: ~¢cr
Street: (a 1S
City: (+A.;
State: ~~
Telephone Number: { '~-~ % 1- _
Fax Number: ( ~t ~ 1-
~~ Nt W Title: ~ouNTV ~ c ~r^~.gs~o~ E~
r~RcoN ~P.EE? ~rn 1~0 '
X01.1 G't~r
~tofz~~n Zip Code: G312t2-
2~°~6- ~3nn
2~S - ~h2C~
PERMITTING CONTACT (if different from applicantloperator above)
Contact's Name: ~-Ni~lt:srt S. ~1_~-0
Company Name:
Tille: ~N~SM)-~r~Nt_~GdtclSlsT
Street: T1'~~ ~x '3~'
City: ~orot?11X I
Stater ~~t.oR~(~n ZipCode:_ 112-7j
Telephone Numbet: ( ~ °~ 1 - 94-Z- 4l'1 f3
Fax Number: ( ~~ °) 1 _ 9q Z - ~¢-\ ~ Q,
INSPECTION CONTACT
Contact's Name:
Company Name:
Street:
City:
State:
Telephone Number
Fax Number:
~i4u1r ~-eAltuty![T Title: ~[+y~0 ~~~J,
~Cron1-t ~ ytNt~ ~ X12 ~Ql ti ~EC?T
CC: STATE ~ L WNER (if any)
Agency: St'Art6 LAND Tp~'R D
Street: /3l3 SNt2MQrJ ~TQ-t=ET ~oh~ (/2.0
City: ~~ N ~ t~CG
State: t![`LclzPrDC? Zip Code:- ~Cl93
Telephone Number: ( ~~ 1- g~~o - 31-59- ~r t- ~ilrw ~~-~ ~L~~
CC STATE OR FEDERAL WNER (if anyj
Agency:
Street:
Ciri:
State:
Zip Cade:
Telephone Number: ( 1-
t~as'LO 2PDt7 Zip Code: t/ 12.1'L
[ ~[z7 ~- ~'3/- - `'1 ~i20 Cfz °X1 Z' ~t23~t-
( ~`~ 1- 2'~S- ~~Zln