2022-04-20_PERMIT FILE - M2021068

• Permit No: M2021068
• IBM Index Class Name: Permit File
• Doc Date: 4/20/2022
• Doc Name: Application
• From: Jack D Tabb, LLC
• To: DRMS
• Email Name: MAC
• Email Name: AWA
• Email Name: BFB
• Media Type: D
• Archive: No

-2-
7. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: Joseph Forster Title: Manager
Company Name: JACK D TABB,LLC.
Street/P.O. Box: 1615 Saratoga St. P.O.Box:
City: AnUgo
State; W I Zip Code. 54409
Telephone Number: 71(5 - 610-2402
Fax Number ( -
PERMrMNG CONTACT (if different from applicant/operator above)
Contact's Name: Title:
Company Name:
Street/P.O.Box: P.Q.Box:
City:
State; Zip Code:
Telephone Number: ( )Fax Number: ( )-
[NSPECTION CONTACT
Contact's Name: Title:
Company Name:
Street(P.O.Box: P.O.Box:
City:
State: Zip Code:
Telephone Number: ( )Fax Number: - 1�-
TATE OR FEDERAL LANDOWNER ifan
Agency:
Street:
City:
State: Zip Code:
Telephone Number: -
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency.
Street:
City:
State: Zip Code:
Telephone Number: j )-