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Your Phone Number* <br /> Used only to follow up. <br /> 5709549063 <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 /> as specific as possioi(, <br /> Comment/Objection Narrative <br /> Mining scars on the hogback,Air quality,Truck traffic/congestion, SH 93 and 56th, Noise, machinery <br /> Permit Number* <br /> Enter valid letter and then numbers,for example M1977999, M1999777UG or C1981201. <br /> M1976007 <br /> Permitting Action Type <br /> Select revision type or leave blank if comment pertains to a new permit application or NOI <br /> Permit Type <br /> County* <br /> Jefferson <br /> Enter one county only <br /> Site Name <br /> Perm ittee/Operator Name <br /> ADDITIONAL INFORMATION <br /> Are there supporting photos, maps, or documents you wish to upload? <br /> Yes • No <br /> By submitting this form electronically you agree to receive any/all follow up correspondence from the Division of <br /> Reclamation, Mining,and Safety at the email address you have provided. <br />