2012-03-21_REVISION - M2001106

• Permit No: M2001106
• IBM Index Class Name: REVISION
• Doc Date: 3/21/2012
• Doc Name: 112 PERMIT APPLICATION FORM
• From: HUERFANO COUNTY
• To: DRMS
• Type & Sequence: CN1
• Email Name: TC1
• Media Type: D
• Archive: No

11. Correspondence Information:
APEL1CANT/OPERATOR (name, address, and phone of name to be used on permit)
Melanie Bounds
HUERFANO COUNTY GOVERNMENT
401 Main Street, Suite 105
Walsenburg
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
PERMITTING CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
CC: STATE OR FEDERAL
Agency:
Street:
City:
State:
Telephone Number:
Agency:
Street:
City:
State:
Telephone Number:
COLORADO
( 719 ..738-3053
( 719 ) _ 738-3996
- 3 -
(if different from applicant/operator above)
JOE GAGLIANO
L J DEVELOPMENT, INC.
256 N. MERRILL DRIVE
PUEBLO WEST
COLORADO
t 719 ) _ 240-9424
719 1 _ 583-0583
CC: STATE OR FEDERAL LANDOWNER (if anv)
Melanie Bounds
HUERFANO COUNTY GOVERNMENT
401 Main Street, Suite 105
Walsenburg
COLORADO
( 719 _ 738-3053
( 719 i.
LANDOWNER (if any'
N/A
N/A
Ti Road & Bridge Administrator
P.O. Box:
Lip Code: 81089
Tnkr CONSULTANT
P.O. Box:
zi c 81007
Ti Road & Bridge Administrator
P.O. Box:
Zip C 81089
Zip Code:
Zip Code:
-