PERMFILE57631

• Permit No: M2004053
• IBM Index Class Name: Permit File
• Doc Date: 7/21/2004
• Doc Name: Application
• From: Riveras Excavation
• To: DMG
• Media Type: D
• Archive: No

-3-
14. Correspondence Information:
APPLICAN'T'/OPERATOR (name, address, and phone of name to be used on pemut)
Contact's Name: ~~Pr / ~ln . ~ ~t VF Q KJ Title: /9-UJ /'If~YL
Company Name: ~r U fJ2 ~C ~ Lr A IJ ~ ~lOol(
Street/P.O. Box: n. ~ . R /i ~ o~'-~ P.O. Box:
city: ~m A-~-/a
State: Nl?~ ~N~ti1G/GG Zip Code: f~7~/ Z
Telephone Number: (.ar~S 1- KA6 - /059
Fax Number: ( ] -
PERMITTING CONTACT (if different from applicanUopera[or above)
Contact's Name: / Title:
Compaq Name: ~~/17 ~ !iS G~ ~ dE.
StreeUP.O. Box: P.O. Box:
Telephone Number: ( 1-
City:
State:
Telephone Number:
Fax Number:
Zip Code:
CC: STATE OR FEDERAL LANDOWNER (if a~
Agency: ~Q~C
Street:
INSPECTION CONTACT
Contact's Name:
Compaq Name:
Street/P.O. BOX:
Clty:
State:
Telephone Number
Fax Numlx~:
Zip Code:
Y/ mF . Ii C ~ `7rJ rJf, Title:
.O. BOX:
Zip Code:
CC: STATE OR FEDERAL, LANDOWNER (if any]
Agency: /') 4 ~
Street:
City:
State:
City:
State:
Telephone Number: ( ~ -
Zip Code: