REV103703

• Permit No: M1988101
• IBM Index Class Name: Revision
• Doc Date: 2/18/2000
• Doc Name: SALES RECEIPT
• From: DMG
• To: ELBERT CNTY
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-~-
13. Correspondence Information:
ti
APPLICANT/OPERATOR (name, address, avd phone of Dame to be used on permit)
Comact's Name: ~ ~, ~.e f
Company Name: p, 1
Street: _ F : ~ . (~~,y ~ 1~ 1 ~ ~.d`sx~=1,~~ ~n ,P S k
Citt-. k' r ~ ~
Stale: L' O Zip Code: eC ~~ t~
Telephone Number: b~J - ~7- ~ ' 313. '1 15' eJ~ - '~~ ~R
FaxNtunber: '?j,_~~- ~ Q`~-1-31~~~ X19 St-11- a-~i~-lp
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name:
Company Name:
Street:
Ciry:
State:
Telephone Number.
Fax Number.
INSPECTION CONTACT
Contact's Name: -~-t
Company Name:
Sheet:
City:
State:
Telephone Number:
Fax Number:
Zip Code:
~`, r~.. S~ e r i c1 cir~ Title: ~o c e M4~ S', c`. ~ci
~lYlw r~- Co..~,r`-~-~C.,o~err.e~.r r~~F
~` v... ~4
~t"1 Zip Code: ~ ~'Sfi.'~ S
~] ~9-~. S41 a-8a(~
CC: STATE OR FEDERAL LANDOWNER (if anvil
Aeeocy:
Street.
Citv:
State:
Telepbone Number:
Zip Code:
CC: STATE OR FEDERAL LANDOWNER !if and
Agency: .~,/ F'9
Street:
Ciry:
State:
Title: C.~nr.: r ~[.~y~
Zip Code:
Telephone Number: ! 1 -