2004-07-27_REVISION - M1981044 ‎(2)‎

• Permit No: M1981044
• IBM Index Class Name: Revision
• Doc Date: 7/27/2004
• Doc Name: Amendment Application
• From: DMG
• To: Solberg Gravel LLC
• Type & Sequence: AM1
• Media Type: D
• Archive: No

-3-
14. Correapoodence_I4formation
APPLICANTJOPERATOR (name, ~dreLss, and phonecof npa(me to be used on permit)
Contact's Name: t~othe.t-~ .X'lge('q Tide:
Compa~Name: ~ I r t/e.~ LG
streetm.o. Box: ! 3745 C7a r/'~ {-~- 1 oa r1 P.o. Box:
city: ,l~n cr Eon
State: ~ ~OC~~O .55 Zip Cade: gi~g`~ ~ -710~~
Telepha~ne Number: (~ ~ ~ ) - ~O8 ~ ~ J ~9
Fax Number. ~ 1 - ~ g 3 - ~.3~3
PERMITTING CONTACT (if different from applicanUoperator above)
Contact's Name: Title:
Company Name:
StreedP.O. Box: P.O. Box:
City:
state:
Telephone Numlr~:
Fax Number.
INSPECTION CONTACT
Coatad's Name:
Casapany Name:
StraeUP.O. Hox:
Title:
Zip Code:
P.O. Box:
City: f1SY1
state: /or~~d zip code: S~g~ I - 762D
Telephone Number: (7/9
)- t/O~~'
3~'
7
~
Fax Number: ~
,/
-
7
~~ ~-7 ) _ ~ ~ `t 3

CC: STATE OR FEDERA L LANDOWNER (if anv)
Agency: /~/~/U~

Street:

City:

State: Zip Code:
Telephone Number: ( ) -

CC: STATE OR FEDERA L. LANDOW
N
ER of any]
Agency: /
~
/V ~~J(o

Street:

City:

State: Zip Code:
Telephone Number: ( ) -