2012-11-21_REVISION - M1997015

• Permit No: M1997015
• IBM Index Class Name: REVISION
• Doc Date: 11/21/2012
• Doc Name: Submittal
• From: Washington County
• To: DRMS
• Type & Sequence: AM1
• Media Type: D
• Archive: No

11. Correspondence Information:
APPLICANT /OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Jason Lid
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
Washington County Road & Bridge Dist. 2
501 4th Ave.
Otis
CO.
( 970 ) _ 246 -3347
(970 ) _ 246 -3347
- 3 -
Title: Road Supervisor
P.O. Box:
Zip Code: 80743
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: ( ) -
Fax Number: ( ) -
INSPECTION CONTACT
Contact's Name: Jason Lockard Title: Road Supervisor
Company Name: Washington County Road & Bridge Dist. 2
Street/P.O. Box: 501 4th Ave P.O. Box:
City: Otis
State: CO Zip Code: 80743
Telephone Number: ( 970 ) - 246 - 3347
Fax Number: ( 970 ) - 246 - 3347
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: ( )