2010-09-29_REVISION - M1989023

• Permit No: M1989023
• IBM Index Class Name: REVISION
• Doc Date: 9/29/2010
• Doc Name: Submittal.
• From: Clyde and Marie Couch
• To: DRMS
• Type & Sequence: AM2
• Media Type: D
• Archive: No

-2-
11. Corresnondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Clyde and Marie Couch Title: Owner
Company Name:
Street/P.O. Box: 122 State Street P.O. Box:
City: Sterling
State: CO Zip Code: 80751
Telephone Number: ( 970 ) - 522-1239
Fax Number: l--? -
PERMITTING CONTACT (if different from applicant/operator above)
Contacts Name: Randy Schafer Title:
Company Name:
Street/P.O. Box: 40586 Co. Rd. 21 P.O. Box:
City: Haxtun _
State: CO Zip Code: 80731
Telephone Number: (970 774-6264 (Home) 970-854-3778 (Work) 970-520-0502 (Cell)
Fax Number: (970 1-854-3811
INSPECTION CONTACT
Contact's Name: Clyde Couch (Winter Address) Title: Owner
Company Name:
Street/P.O. Box: 14231 103rd Ave P.O. Box:
City: Sun City
State: AZ Zip Code: 85351
Telephone Number: (623 ) _ 815-0012
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: ( 1-