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2005-11-21_REVISION - M1992045 (2)
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2005-11-21_REVISION - M1992045 (2)
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Entry Properties
Last modified
6/15/2021 2:45:03 PM
Creation date
11/21/2007 10:12:23 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1992045
IBM Index Class Name
Revision
Doc Date
11/21/2005
Doc Name
Reclamation Permit Application Package
From
James VanElla
To
DMG
Type & Sequence
AM1
Media Type
D
Archive
No
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<br />i <br />-L <br />9. <br />Contact's Name: ~- <br />Company Name: ~! <br />Street i~y~~ - <br />City: <br />State: ~ <br />Tel hone Number: <br />~~ <br />Contact's Name: <br />Company Name: <br />Street: <br />Ciry: <br />State: <br />Telephone Number: ~ ~ - <br />Fax Number: ~ r - <br />iNSPF.CTiON CONTACT•_ <br />Contact's Name: <br />Company Name: <br />Street: <br />City: <br />State: <br />Telephone Number: .~ )_ - <br />Fax Number: ~ ~ - <br />('['• STATE. AR FFDFRAi. i.ANIIOWNF.R (if any): <br />Agency: <br />Street: <br />City: <br />State: <br />Telephone Number: ~ ~ - <br />f'['e STATE. (1R FF.DFRAi.I.ANDOWNF.R ($any): <br />Agency: <br />Street: <br />City: <br />State: <br />phone of name to be used on permit): <br />!.~ <br />Title: . <br />Zip Code: .~0~~ <br />Title: <br />P.O. Box: <br />Zip Code: <br />Title: _ <br />P.O. Box; <br />Zip Code: <br />Zip Code: <br />Zip Code: <br />Telephone Number: <br />~a~~ ~-l~~~s-~0~6 <br />~a~lno ~-~olP~- 0362 <br />)NTA('T (if different from applicanUOperator above): <br />
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