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-2- <br />3. Address and Phone Number of r} � 0 1� . // 3 0-3 — ' Yl <br />Local Offices <br />U (V y/ S err,' Ool, 0 Yi a-30 <br />4. Address and Phone Number of S11 1pi C tl v <br />General Offices <br />9. Type of Mine and Substance to be Mined &e Lc a 7 ,1� /`2' -S al, <br />(Specify underground, open pit, <br />quarry, etc. & substance(s) to <br />be mined) <br />10. General Location and Elevation S sf' c l 7-YeAl e f L ` / <br />(Miles & direction from nearest c1 �'�E,� S ' �,y,y, ,�o/V <br />town & approximate site elevation} l r <br />11. County P V VAl /, S 9l/ <br />12. Acreage of Affected Lands j <br />(Total surface acreage to be (( <br />included in permit) <br />13. Application Fee (See applicablet <br />Rule to determine amount) ' <br />Person <br />�= v I A `��'� <br />5. Name and <br />Phone Number of <br />Staff Members Should Contact <br />J 0,3 —c/a s 9 <br />b. Owner(s) <br />of Record of Affected Land <br />��� L��N r <br />(surface <br />area) ( If more than 2, <br />list below) CV0 e ` llexl/ye f <br />7. Owner(s) <br />of Substance to be Mined <br />e�"~h�''r /v CIP SPA,— <br />(If more <br />than 2, list below) <br />8. Source of <br />Legal Right -To -Enter <br />1116 , } Ir v G %/ e � <br />(Indicate <br />what type of proof is <br />included <br />in EXHIBIT G - lease, <br />deed, notarized <br />letter, etc.) <br />9. Type of Mine and Substance to be Mined &e Lc a 7 ,1� /`2' -S al, <br />(Specify underground, open pit, <br />quarry, etc. & substance(s) to <br />be mined) <br />10. General Location and Elevation S sf' c l 7-YeAl e f L ` / <br />(Miles & direction from nearest c1 �'�E,� S ' �,y,y, ,�o/V <br />town & approximate site elevation} l r <br />11. County P V VAl /, S 9l/ <br />12. Acreage of Affected Lands j <br />(Total surface acreage to be (( <br />included in permit) <br />13. Application Fee (See applicablet <br />Rule to determine amount) ' <br />