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

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11. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: C,wA Nit _ ►If�jti J Title:
Company Name:
Street/P.O.Box: =0g4,5 1 I , m—, { I�Q� P.O.Box:
City: G EAD-A
State: ( b Zip Code:
M18
Telephone Number: ( '1 1 -1 )- -414
Fax Number: ( )- A r)AJE
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
Contact's Name: �� 1 _ tt I�a1/�5 Title:
Company Name:
Street/P.O. Box: X74S k COU'Af-T-1 R64b� 3 P.O. Box:
City:
State: �(� Zip Code:
Telephone Number: - 71,3—c- '4
Fax Number: ( )- .1jcdt--
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency: JL)_ A
Street:
City:
State: Zip Code:
Telephone Number: ( )-
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( )-