2005-11-07_REVISION - M1983141

• Permit No: M1983141
• IBM Index Class Name: Revision
• Doc Date: 11/7/2005
• Doc Name: Amend. Appl
• From: Mount Royale Ventures LLC
• To: DMG
• Type & Sequence: AM2
• Media Type: D
• Archive: No

-z-
9. Cnrrea~nnndenrr infnrmatinne
APPi.iCANT/OPFRAThR (name, address, and phone of name to be used on permit):
Contact's Name:
Company Name:
Street:
City:
State:
Tille: ~~n't-- AAA,~MPi~~
~. C7 ~o~ ~C(-a-S~ ~ P.O. Box: ~ ~1 ~F'~ `t
~se~t llp(L
`~npto~pU Zip Code: ~030~
Telephone Number: r 303 i _ SIB - 3~{ O
Fax Number: ! ~~ )- - S~o~ - ~ ~~ ~'
PF.RM7TTiNG CANTACT (if different from appliCandoperator above): ,1 A , , , ,
Contact's Name: ~~ ~t7L~--~yS t ~ ~ ,, Title: ~^~ ~"~
Company Name: ~IAtT- ~/+-t.,:r ~1~~ve-~~ , U C_
street. ~I t~4~ Snls.~t,.~ r?k~~ D2. r.o. Box: ~G ~-~(
City: 17b:)l.l~'~-
State: ~ r9e~Y7 Zip Code: ~O?,fY~-~
Telephone Number ~ ~'~~ .)_ - ~~ - ~ ~ y~
Fax Number: r ~~ 1 - SAS- ~`'t ~'~
Contact's Name:
Company Name:
street:
City:
State:
Title: ~~ ~ ~~~ ~" ~l-
~~~ ~til~lt.a~ eA,JtPaa O~ pp. Box: iCi`x-'~
'~c.~~~-
eCID ~ Zip Cade: ~~ fl
Telephone Number: ~ ~' ZS~ ~ - S(o S~ ~ ~y ~~
Fax Number: ~ ~~ )- - X05 - ~~~~
CCe CTATF (1R FF.DF.RA7.7.ANIiOWNF.R (if any):
Agency: V `~ ~~cA~IQ~fC At=- 1n1T~-2-10/Z {~~-~
Street: ~ 1~ ~AS"r ~ A.,J ~z~T
City: [ ~y.utir ~~ ~t
State: ~+-C1~2piJb Zip Code: ~' 2 ~ Z
Telephone Number: ~~ - Z~ ' O ~/ 2~-
CCc RTATR nR FF:DF.RA7.7.AN7iAWNF.R (if any):
Agency:
Street:
City:
State:
Zip Code:
Telephone Number: