Stormwater - Affiliates

Facility Name: KUM & GO #521 - CONSTRUCTION

Permit Type: GP #2 - Construction Activity Legal Status: Private File No: 26792 Authorization No: 26792-26553

Expiration Date: 5/1/2016(discontinued) Address: 205 2ND ST. - COALVILLE , IA 52241

County: JOHNSON Field Office: 6 SIC: Geospatial Information: 619520(X)/4613895(Y) (Electronic app)

Affiliates

Individual?

Type:*

Name:

Title:

Company Name:

C/O:

Address:

Address 2:

City/State/Zip

E-mail:

Contact Owner

Preferred Method of contact

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