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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 />Excessive truck traffic on county road 35. <br />Increase in dust pollution. <br />Increase in noise pollution. <br />Probable decrease in property value. <br />This project will pull water from our area, causing our well that we use for our daily water to run low or even dry. <br />(We are not on city water) <br />Decrease in local wildlife. <br />Increased traffic will cause faster degradation of our roads. <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 />New permit <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 />