2012-07-09_REVISION - M2010036

• Permit No: M2010036
• IBM Index Class Name: REVISION
• Doc Date: 7/9/2012
• Doc Name: APPLICATION FOR A CONVERSION
• From: RANDY SCHAFER
• To: DRMS
• Type & Sequence: CN1
• Email Name: BMK
• Media Type: D
• Archive: No

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11. Correspondence Information:
APPLICANT /OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: BreCk Vassios Title: Owner
Company Name: Crystal Springs Ranch Inc.
Street/P.O. Box: 108 E. 6th Street P.O. Box: 389
City: Flagler
State: CO Zip Code: 80815
Telephone Number: ( 719 ) _ 765 - 4323, CeII 719 - 349 - 1785
Fax Number: ( ) -
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Randy Schafe 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: Jerry Ritchey Title: Owner/ Operator
Company Name: Ritchey's Redi -Mix Concrete Inc
Street/P.O. Box: 509 S. Idlewild P.O. Box:
City: Yuam
State: CO Zip Code: 80759
Telephone Number: ( 970 ) _ 848 - 5451, CeII 970 - 630 - 3052
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: ( ) -