Stormwater- Affiliates

Facility Name: AVERA HOLY FAMILY HOSPITAL - CONSTRUCTION

Permit Type: GP #2 - Construction Activity Legal Status: Private     File No: 23864   Authorization No: 23864-23611

Expiration Date: 7/1/2016(expired) Address: 820 N. 7TH ST. - ESTHERVILLE , IA 51334

County: EMMET Field Office: 3 SIC: Geospatial Information: 351682(X)/4807985(Y)

Affiliates   Name Address City State Zip Phone Type AVERA HOLY FAMILY HOSPITAL 826 N. 8TH ST. ESTHERVILLE IA 51334 (712)362-6160 Owner MATT DALEN 826 N. 8TH ST. ESTHERVILLE IA 51334 (712)362-6316 Contact Individual? Type:* --AFFILIATE TYPE-- OWNER OPERATOR CONTACT CERTIFIER Name: Title:   Company Name: C/O:   Address: Address 2: City/State/Zip   --Select-- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY PR OT E-mail:   Contact Owner   NO YES Preferred Method of contact EMAIL US MAIL Business Phone:   Error! Phone Number Format Must Be (XXX)XXX-XXXX Ext: Home Phone:   Error! Phone Number Format Must Be (XXX)XXX-XXXX Fax:   Error! Phone Number Format Must Be (XXX)XXX-XXXX Mobile Phone:   Error! Phone Number Format Must Be (XXX)XXX-XXXX