PERMFILE118410

• Permit No: M2004037
• IBM Index Class Name: Permit File
• Doc Date: 5/21/2004
• Doc Name: 1st Submittal Wrong Appl & Exihibits
• From: John M Everitt
• To: DMG
• Media Type: D
• Archive: No

3-
14. Corresmoodeace Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: John M. Everitt
Compatry Name:
Street/P.O. Box: 24274 County Road 17
City:
State:
Telepha~ne Number:
Fax Number:
Contact's Name:
Company Name:
StreeUP.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
Colorado ~ ~ Zip Code: _
L 970 )- 774-7508 C:P/,~,JaD' 4~?
L 1-
(ifdifferent from applicanUoperator above)
SAME Title:
Title: Owner
P.O. Box:
P.O. Box:
Zip Code:
SAMF. Title:
P.O. Box:
City:
State:
Telephone Number:
Fax Number:
CC: STATE OR FEDERAL

L 1-
( 1-
LANDOWNER (if and
Agency: N/A
Street:
City:
State:
Telephone Number: ( 1-
CC: STATE OR FEDERAL LANDOWNER (if anvl
Agency: N/A
Street:
City:
State:
Telephone Number
Zip Code:
Zip Code:
Zip Code: