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Your Phone Number* <br /> Used only to follow up. <br /> 3039174572 <br /> Extension <br /> Alternate Phone Number <br /> Used only to follow up. <br /> Alternate Phone Extension <br /> Connection to Operation <br /> Select all that apply <br /> ✓ Land Owner of affected land ✓ Structure Owner within 200' of affected land <br /> Mineral Owner ✓ Nearby Resident <br /> ✓ Adjacent Land Owner ✓ Concerned Citizen <br /> Government Agency Other <br /> DESCRIPTION OF COMMENT OR OBJECTION <br />