PERMFILE135645

• Permit No: M2007012
• IBM Index Class Name: Permit File
• Doc Date: 2/15/2007
• Doc Name: 112 Application
• From: Gregory Larson
• To: DRMS
• Media Type: D
• Archive: No

-3-
It. CorresoondenceInformation:
APNLiCANT/OPF,RATOR (name, address, and phone of name to be used on permit)
Contact's Name: ~Eg~-~ iarcnn Title: Owner/Operator

Company Name:

S1reeUP.O. Box: t X977 rte- Rrl _ 97 P.O. Box:
Ciry: xaxtun
State: CO _ ZipCode: 80731
Telephone Number: ( 970 1- 774-6231 970-580-3119 (Cell)

Fax Nutnber: ( 1-

PER HITTING CONTACT (if different from applicanUopexator above}
Contact's Name: Rand3r Rrhafer Title: Consultant

Company Name:

SKectlP.O. Box: 405RF, Cn _ Rd- 21 P.O. Box:
City:

State: l'O "Lip Code: 80731
TelephoneNtunber: ( 970 1- R54-3798 (Work) 970-774-6264 (Home)
Pax Number: f 970 ~- 854-3811 (Work)

INSPECTION CONTACT
Contact's Name: (_ragpry Larann Title: Owner/Operator

Company Name:

Street/P.O. Box: 14977 o Rd- 97 P.O. Box:
Clfy: Haxtnn _

State: rn Zip Code: 80731 _
Telephone Number: ( 970 )- 774-6231 970-580-3119 (Cell)

Fax Nttmber. ( 1-

CC STATE OR FEDERAL LANDOWNER (if any]
Agency:

Street: ___
______
City:
----- -- -
State: __ ,__i . Zip Code: , __
Telephone Number: ( ) - ___
__
CC S'CA'CE OR FEDERAL LANDOWNER (if anv)
Agency:

Sneer _ _

City: -------
- --
State: --_- --__-~ Zip Code: _ _ ---
Telephone Number. ( 1- __- ~ _~_ _____ __