2013-09-03_REVISION - M2005044

• Permit No: M2005044
• IBM Index Class Name: REVISION
• Doc Date: 9/3/2013
• Doc Name: Conversion Application
• From: Lincoln County
• To: DRMS
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-3-
11. Correspondence Information.
APPLICANT /OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: `fit DrrM
Title: Land Use Administrator
Company Name: Lincoln County
Street/P.O. Box: 103 3rd Avenue
P.O. Box: 39
City: Hugo
State: Colorado
Zip Code: 80821
Telephone Number. ( 719 ) _ 743 -2337
Fax Number: ( 719 ) _ 743 -2815
PERMITTING CONTACT (if different from applicantlopemtor above)
Contact's Name: Same as above
Title:
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:
John DeWitt
Lincoln County
103 3rd Avenue
P.O. Box:
Zip Code:
Title: Land Use Administrator
P.O. Box: 39
Hugo
Colorado Zip Code. 80821
Telephone Number. ( 719 ) _ 743 -2337
Fax Number. ( 719 ) _ 743 -2815
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: ( -