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-2- <br /> 3. Address and Phone Number of 20`fC G )2vi9 r> '7 - 4 S <br /> Local Offices DEi_;A ,6a. 81ylly <br /> 4. Address and Phone Number of SA r4 E' <br /> General Offices <br /> 5. Name and Phone Number of Person HA rz01- 0 Lo i s B KA ti D 5TA D T <br /> Staff Members Should Contact 7,74 - Y/ -3-- <br /> 6. Owner(s) of Record of Affected Land RA&V LD B R A ND SrAb 7- <br /> (surface area) (If more than 2, list below) LnlS BAArJDSrADT <br /> 7. Owner(s) of Substance to be Mined HAROLD BfZA••jDsrAD i <br /> (If more than 2, list below) Lo 1 s J3RAhi05TA 0 7- <br /> 8. Source of Legal Right-To-Enter Copy or- TAx 2ECEJPT <br /> (Indicate what type of proof is <br /> included in EXHIBIT G - lease, <br /> deed, notarized letter, etc.) <br /> 9. Type of Mine and Substance to be Mined Card <br /> (Specify underground, open pit, <br /> quarry, etc. & substance(s) to °`"" <br /> be mined) <br /> 10. General Location and Elevation E Le V • <br /> (Miles & direction from nearest RpPQcX �( D iTA <br /> town & approximate site elevation) <br /> 11. County De L T A <br /> 12. Acreage of Affected Lands <br /> (Total surface acreage to be A � ' <br /> included in permit) <br /> 13. Application fee (See applicable <br /> Rule to determine amount) <br />