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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 <br />Mineral Owner <br />Adjacent Land Owner <br />Government Agency <br />Structure Owner within 200' of affected land <br />� Nearby Resident <br />✓ Concerned Citizen <br />Other <br />DESCRIPTION OF COMMENT OR OBJECTION <br />You are providing a comment or objection to the public record of a permitting action currently under review by the Division of <br />Reclamation, Mining and Safety. Thls form Is not intended for reporting of possible violations or illegal activity. Please be as specific <br />as possible. <br />Comment/Objection Narrative * <br />We live 1/2 mile away from the sight. Our only water for our home is well water. It has been said that a gravel pit <br />will effect and take ground water up to a mile. Therefore, we would be without water. We also have a business <br />in our home. Without our well water we would also lose a household income. Please do not let this gravel pit be <br />put in at the location near WCR 394. <br />Permit Number'k <br />Enter valid letter and then numbers, for example M1977999, M1999777UG or C1981201. <br />M2021067 <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 />Weld <br />Enter one county only <br />Site Name <br />Permittee/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 />