2009-11-24_REVISION - M1984043

• Permit No: M1984043
• IBM Index Class Name: REVISION
• Doc Date: 11/24/2009
• Doc Name: Notices
• From: DRMS
• To: Various
• Type & Sequence: CN1
• Email Name: PSH
• Media Type: D
• Archive: No

-3-
11. CorresMdence Information.
ARPLICANT/OPERRf T_OR (name, address, and phone of name to be used on permit)
Contact's Name: Scott Pelino Title: Pres.
Company Name: Pelino!. Inc.
Street/P.O. Box: 33551 CR 361 P.O. Box: 5-049
Buena Vista
City:
State: Colorado Zip Code: 81211
Telephone Number: ( 719 ) - 395-2093
Fax Number:
saute
L } _
PERMITTING CONTA CT (if different from applicant/operator above)
Contact's Name: Jon Roorda Title. Land Surveyor
Company Name: Arkansas Valley Surveying
Street/P.O. Box: 28350 CR 317, unit 9 P.O. Box: 1111
City: Buena Vista
State: Colorado Zip Code: 81211
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name.
Sbwt/P.O. Box:
City:
State:
Telephone Number: ( -
Fax Number: [ _ -
CC: STATE OR FEDERAL LANDOWNER may)
Agency:
Street:
City:
State: Zip Code:
Telephone Number. ( ) -
CC: STATE OR &DE__AL LANDO WNER (if any)
Agency:
Street:
Citv:
State: Zip Code:
Telephone Number: .1-
719 395-3185
( ) . same
Satre as Applicant/Operator
Title:
P.O. Box:
Zip Code: