REV88872

• Permit No: M1984134
• IBM Index Class Name: Revision
• Doc Date: 9/30/1996
• Doc Name: CONSTRUCTION MATERIALS REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-3-
14.
Correspondence Information:
APPLICANT/OPERATOR (name, address, and
COntaCt'8 Name: ,T TM CTDF.Af1TT(
phone of name to be used on p
1M Title:
rmit)
'OR
Company Name: PROWERS COUNTY
street:
City:
State: CO. Zip Code: 1052
Telephone Number: ( 719 ~ - 336-9001
Fax Number: ( 719 1 -
PERMITTING CONTACT (if different from
Contact's Name: JIM SIDEBOTTOM applicant/operator above)
Title:
MINISTRATOR
Company Name: PROWERB COUNTY
street: P 0 BOX 1046
City: LAMAR
State: CO Zip code: 81052
Telephone Number: ( 719 ~ _ 336-9001
Fax Number: ( 719 1 - 336-2255
INSPECTION CONTACT
Contact's Name:
JIM SIDEBOTTOM
Title:
MINISTRATOR
Company Name: PROWERS COUNTY
Street: P 0 SOX 1046
City: LAMAR
State: CO Zip Code: 81052
Telephone Number: { 719 ~ _ 336-9001
Fax Number: ( 719 1 _ 336-9001
CC: STATE OR FEDERAL
Agency: LANDOWNER (if anv l
Street:
City:
State: Zip Code:
Telephone Number: ( ) -
CC: STATE OR FEDERAL
Agency: LANDOWNER fif anv l
Street:
City:
,State: Zip Code:
Telephone Number: ( ) -