2021-07-16_PERMIT FILE - M2021048

• Permit No: M2021048
• IBM Index Class Name: PERMIT FILE
• Doc Date: 7/16/2021
• Doc Name: Application
• From: Zak Dirt, Inc.
• To: DRMS
• Email Name: ERR
• Email Name: JDM
• Email Name: JXT
• Media Type: D
• Archive: No

-3 -
15. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: C o e ( ILA v F,"►A✓ Title: P9-0 3 dcr C nib s v m 2
Company Name: l p w- o f a.r I ry C
Street/P.O.Box: 07,40 HILLTOP (R 0 P.O.Box:
City: L0 M6,MC.M'-
State: Lo 1.0()-A 0 o Zip Code: 8 0 s'o N
Telephone Number: 4 L 6"?�
Fax Number:
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: SAME AS h PP"CAn.T_ Title:
Company Name:
Street/P.O.Box: P.O.Box:
City:
State: Zip Code:
Telephone Number: (_�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: ( )-
-4-