PERMFILE64761

• Permit No: M2005075
• IBM Index Class Name: Permit File
• Doc Date: 12/19/2005
• Doc Name: Submittal of Appl. Form
• From: Oldcastle SW Group Inc. dba Four Corners Materials
• To: DMG
• Media Type: D
• Archive: No

-3-
11. Corresoondence Information:
APPLICANT/OPERATOR (name, address, and'' p//hone of name to be used on permit) n
Contact's Name: ~1^PS-~ LC/.f cr'- Title: 1(rose,.-~ ' I~ve./s'
Compa~Name: ~Iril~~ l.ow...rby~1'[~
Street/P.O. Box: ZZ~ ~ R, tni r- ~d P.O. Box:
city: Gra..d ~~„~,~-h~ ~.
State: GO Zip Code: ~I SC~2
Telephone Number: (9~ c) ) - Z43 - y`)OO
Fax Number: (~ ~O ) - Z~l 3 _ r, q ~/~
PERMITTING CONTACT (if different from applicanUoperator above)
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Strcet/P.O. Box:
Ciry:
State:
Telephone Number:
Fax Number:
C ,O Zip Code: O V / SZf
f~LU )-_6YZ ~3Z(
f 3 1- 3y,~ 69~~
QT ~ ~t'c~ Title:
Zip Code:
Title:
P.O. Box:
P.O. Box:
CC: STATE OR FEDERAL LANDOWNER (if env)
Agency:
Shcet
City:
State:
Telephone Number:
Code:
CC: STATE OR FEDERAL LANDOWNER (if any]
Agency:
Street:
City:
State:
Code:
Telephone Number: f ) -