2010-08-06_PERMIT FILE - M2010054

• Permit No: M2010054
• IBM Index Class Name: PERMIT FILE
• Doc Date: 8/6/2010
• Doc Name: 110C New Application
• From: Timothy D. Williams & Betty J. Williams
• To: DRMS
• Email Name: PSH
• Media Type: D
• Archive: No

-2-
11. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Timothy D. Williams & Betty J. Williams(>r Title: owner
Company Name:
Street/P.O. Box: 5588 CR 210 P.O. Box: 243
City: Walsenburg
State: Colorado Zip Code: 81089
Telephone Number: ( 719 ) - 738-6263
Fax Number: ( ) -
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number: L ) -
Fax Number: ( ) -
INSPECTION CONTACT
Contact's Name: Timothy D. Williams Title:nwner
Company Name:
Street/P.O. Box: 5588 rR Ain P.O. Box: 243
City: Walsenburg.
State: Cn1 orarln Zip Code: 81089
Telephone Number: ( 719 738-6263
Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) -