2008-03-31_PERMIT FILE - M2008020

• Permit No: M2008020
• IBM Index Class Name: PERMIT FILE
• Doc Date: 3/31/2008
• Doc Name: New 110c Appl
• From: Dolores County
• To: DRMS
• Media Type: D
• Archive: No

o EXHIBIT I o
Ins}rumAn~ Bon,F: F'i-~:~~
~t1t~;~Ei~ilC{,33ii OR 371 333
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11. Cgrrespondence Informat3oa:
APPLICANT/QP~~;RATOR (Warne, address, and phone of name to be used on permit)
Contact's Name: _ Tim Huskey Title: _ Road Supervisor
CompanyN2unc: Dolores ounty Road & Bridae ~Qpt .
Street/P.O. Paz: 1 Q 1 Q N. G u y r e n e P.O. Box: 6 0 8
City:
State: C O Zip Code: _ _. $13 2 4
Telephone Number: 9~ 7 0_~ - 6 7 7.- 2 3 2 8
Fax Number: ( 970 )- 677-3759
$BRMITTING CONTACT {if different from applicant/operator above)
Contact's Na~r~e: Title:
Company Name:
Street/P.O. Bax: P.O. Bax:
City:
State:
Zip Code:
Telephone Niunber: [ ,_,•, ) -
Fax Number. { ,) -
INSPECTION COI`dT'ACT
Contact's NaW~: Tim Huskey Title: R o a-~ S u p.,ex V 3..~~ r
CompanyNarne: _____.Dolores__ County Road ~ Br; raga na~t _
Street/P.O. Box: ], ~ ], (Z~ , !~~~ y r a n ~ P.O. Box: 0 8
City: • • Dove Creek
State: _ CQ Zip Code: 813 2 4
Telephone Number: { 9 7 0 ,~ - 6 7 7- 2 3 2 8
Fax Number: ! 970 )- 677-3759
CC: ~'~ATE O$FE:DERAL LANDOWNER (If env)
Agency: ~_
Street:
City:
State: Zip Code• .
Telephone Number: t ) -
CC: STATE Oft FE:DIaRAL LANDOWNER /if anvl
Agency:
Street:
City:
State: Zip Code:
'1'etephane Number: {__-____,-___,-„~ -