2018-12-06_REVISION - M2012013

• Permit No: M2012013
• IBM Index Class Name: REVISION
• Doc Date: 12/6/2018
• Doc Name: Request For Amendment To Permit
• From: John & Brenda Higgins
• To: DRMS
• Type & Sequence: AM2
• Email Name: JPL
• Email Name: MAC
• 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: J Fi NN 14 164 W`J Title:
Company Name:
Street/P.O.Box: ol`��� (jm i`j �U�9->b P.O.Box:
City: ELw DA
State: Zip Code: ��)8
Telephone Number:
Fax Number:
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: SAME Title:
Company Name:
Street/P.O.Box: P.O.Box:
City:
State: Zip Code:
Telephone Number: ( )Fax Number: ( ?-
INSPECTION CONTACT 1
Contact's Name: J icI-W W , I�a{/�� Title:
Company Name:
Street/P.O.Box:
^ P.O. Box:
City: b A
State: _r�� (�y Zip Code:
Telephone Number: ( 1('1 1- '71. —cM i
Fax Number: ( )- A c"IL
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency: MIA
Street:
City:
State: Zip Code:
Telephone Number: )-
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency: t4 A
Street:
City:
State: Zip Code:
Telephone Number: ( )-