2008-07-24_REVISION - M1978072

• Permit No: M1978072
• IBM Index Class Name: REVISION
• Doc Date: 7/24/2008
• Doc Name: Conversion Submittal
• From: Lincoln County
• To: DRMS
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-3-
It. CorrgMgdenee Information:
APPLI ANTIOP.ERA`COR (name, address, and phone of name to be used on permit)
Contact's Name: K e nn P t h M n r r i G n n Title: e n d U s ca a d n' i-n-i-s-t r a t o r
Company Name: Lincoln County -
Street/P.O. Box: 103 3RD Avenue P.O. Box: 3 9
City: Hugo
State: Colorado _ Zip Code: 8 0 8 21
Telephone Number: ( 719 ) _ ?7 4 3 - 2 3 3 7
_
Fax Number: L 719 1- 743-2815
PERMITTING CONTACT (if different from applicantioperator above)
Contact's Name: Title: _
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number:
Fax Number: ( ) - W
INSPECTION CONTACT
Contact's Name: Kenneth Morrison Title' Land Use Admin
Company Name: Lincoln County
Street/P.O. Box: 103 3rd Avenue P.O. Box: 3 9
City: Hugo
State: COLORADO Zip Code: 800 821
Telephone Number: 77119 )- 743-2337
Fax Number: ( 719 ) - 743-2815
CG: STATE OR FEDERAL LANDOWNER if an
Agency: ......... __
Street:
City:
State: ------ .-...... -- Zip Code:
Telephone Number:
.__.__?_.__? __-_--
CC: STATE OR. FEDERAL LA??TDC_ OWNER (ifany)
Agency:
Street:
City:
State:
Zip Code:
Telephone Number: ?_-------__,_-?. -