2010-10-14_PERMIT FILE - M2010054

• Permit No: M2010054
• IBM Index Class Name: PERMIT FILE
• Doc Date: 10/14/2010
• Doc Name: Revised 110 Application form for 9.85 Acres.
• 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. Williamroj-

Company Name: Title: owner
Street/P.O. Box: 5588 CR 210

City: Walsenburg P.O. Box: 243
State: Colorado
Telephone Number: ( 719 738-6261
Zip Code: 81089
Fax Number:
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name:
Company Name: Title:
Street/P.O. Box:

City: P.O. Box:
State:
Telephone Number: ( Zip Code:
Fax Number: ( _
INSPECTION CONTACT
Contact's Name: Ti mo by T) Wl
?mq

Company Name:
Title: owap r
Street/P.O. Box: 55RR ('R Zl (1

City: Walsenbur P.O. Box: 243
State: Cnl ^-
a
r
n
Telephone Number: 719
738-6263

Zip Code: 8? 9?Q
Fax Number: ( ) _
CC: STATE OR FEDERAL LANDOWNER if
an
• Agency:
Street:
Cit
y:
State:

Telephone Number: ( _ Zip Code:
CC: STATE OR FEDERAL LANDOWNER if
an
Agency:
S
treet:
Ci
ty:
St
ate:

Telephone Number: ( ) - Zip Code: