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2006-10-24_REVISION - M1989023 (2)
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2006-10-24_REVISION - M1989023 (2)
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Last modified
6/15/2021 2:53:45 PM
Creation date
11/21/2007 8:04:37 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1989023
IBM Index Class Name
Revision
Doc Date
10/24/2006
Doc Name
Amend Appl
From
Clyde and Marie Couch
To
DRMS
Type & Sequence
AM1
Media Type
D
Archive
No
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-2- <br />6. Cones9ondence Information: <br />APPLICANT/OPERATOR (name, address, and phone of name to be used on permit) <br />Contact's Name: G ~!(S.e-- ~L /t'~a M ~ (.-~o[~ Title: _ <br />Company Name: <br />Street/P O Box /y~31 /U'~ t3 e'. P.O. sox: <br /> <br />City: su- ti ~ i ~S~ <br />State: ~Z Zip Code: S~3s( <br /> <br />hone Number: <br />Tele ( e~~ ~ - S3 IS ' y012- <br />p <br />mber: <br />F <br />N ~ 1- <br />ax <br />u <br />PERMITTING CONTACT (if ditTerent from applicant/operator above) <br />Contact's Name: ~~ Q~ Q~+ /1'te~ I'C e- t~ c~•t TiBe: <br /> _ <br />Company Natne: I <br />Street/P.O. Box: 122 y <br />.~ <br />~~-~`e-- s ~'~-u P.O. Box: <br />City: .S f <br />\ i A t') I <br /> <br />state: ~t7 zip code: 8t7~tSy~ <br /> <br />mber: <br />e N <br />h <br />T <br />l ( 1- <br />on <br />u <br />e <br />ep <br />ber: <br />F <br />N ( I - <br />um <br />ax <br /> <br />INSPECTION CONTACT I <br />Contact's Narne: Title: <br /> <br />Name: <br />Co <br />an <br />y <br />mp <br />Street/P.O. Box: P.O, Box: <br />City: <br />State: <br />Telephone Number: ~ 1- <br />Fax Number: ( 1- - <br />CC• STATE OR FEDERAL LANDOWNER (if anv) <br />Agency: <br />Street: <br />City: <br />State: <br />Telephone Number; ( 1- - <br />CC• STATE OR FEDERAL LANDOWNER (if anvl <br />Agency: <br />Street: <br />City: <br />State: <br />Telephone Number; ( ) - - <br />Zip Code: <br />Zip Code: <br />Zip Code: <br />
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