PERMFILE63412

• Permit No: M2006021
• IBM Index Class Name: Permit File
• Doc Date: 4/21/2006
• Doc Name: 112 Permit Application
• From: Glade LLC
• To: DMG
• Media Type: D
• Archive: No

10.
a
Iatormatlon:
's Name:
Name;
~. Box:
Aiea Code:
Fax Number.
I
PERMITTING CONTACT
Inldividual's Name:
Cbmpmy Name:
StreetlP.O. Bax:
I
City:
State:
Area Code:
ax Number:
INSPECTION CONTACT
ladividual's Name:
Company Name:
Street/p.0, Box
RECE! VED
APR 1 1 10D6
(name, address, and phone oftautx to be used on permit) ~~~~sion al Minerals and Geology
SA MC^-~ S"LiZ„\C~Gow Tice: MrcMKt/ft
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I~tO No(;TN Si+rG~LS]s ST. P.O.Box:
~'a2~ COL(.\NS
Gt'~ Zip Code: aOSZg-
( q r1 O 1 Telepha~: 2-t'~i - Co 2 8 2
( °I r7 O 1 Telephone: 44~ Z - 014 9 _
tf diff_e[ent from applic~t/ for above)
(~ . _
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Zip Code: L'~ OSG~
Zip Code:
t Code: ( ~ Telephone:
Numbee ( 1 Telephone:
Agency: ~'C~4YE P~/ktZO O~ (-F4i•1O C-oM(y.\SSlons'..~E,.S
Strcet: \~13 SFIERMRn.~
City: O61Jv ~Q
Srate: ~ Zip Code: a~2O3
Area Code: ( ~J03 1 Telephone: ~(o(o- 3l$L
LATE OR FEDERAL LANDOWNER (lt sav)
Agency:
Street:
City:
State: Zip Code:
Area Code: ( 1 Telephone:
~ShMG ~S /4' DV~1 Title: