REV91998

• Permit No: M1978143
• IBM Index Class Name: Revision
• Doc Date: 5/19/1993
• Doc Name: LIMITED IMPACT OPERATION RECLAMATION PERMIT APPLCATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-2-
9. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: P7. Clark Branstetter, Grand County Road & Bridge Supervisor
Company Name: Grand County
Street: 308 Byers Avenue - Box 239
City: Hot Sulphur Springs
State: Colorado Zip Code: 80451
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: same
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT
Individual's Name: i4. Clark Branstetter, Grand County Road & Bridge Supervisor
Company Name: Grand County
Street: 308 Byers Avenue - Box 239
City: Hot Sulphur Springs
State: Colorado Zip Code: 80451
Area Code: 303 Telephone: [phone]
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: N/A
Street:
City:
State: Zip Code:
Area Code: Telephone:
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency: N/A
Street:
City:
State:
Area Code: Telephone:
Ztp Code: