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uita t�ritu. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly,in the space provided,all information described below <br /> 1.Applicant/operator or company name(name to be used on the permit):Randall K.Kokkinen <br /> 1.1 Type of organization(corporation,partnership,etc.): Sole Proprietorship <br /> 2.Operation name(11it,mine or site name): 9 to 5 <br /> 3.Permitted acreage(new or existing):(must be 5 acres or less)-permitted acres 0.4 <br /> 4.Fees: <br /> 4.1 New Application 2$ 88.00 application fee 5.Primary commoditie(s)to be mined: <br /> 6.Name of owner to the surface of affected land: Forest Service <br /> 7.Name of owner to the subsurface rights of affected land:Forest Service <br /> 3.Type of mining operation: lode exploration(prospecting) <br /> t <br /> 1313 Sherman Street, Room 215, Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us <br /> -2- <br /> 9 Correspondence Information: <br /> APPLICANT/OPERATOR(name,address,and phone of name to be used on permit): <br /> Contact's Name:Title: Randall K.Kokkinen (Owner) <br /> Street: P.O. Box: City: 6751 Golden Sill Court,Castle Pines <br /> State:Zip Code: CO 80108 Telephone Number: 7( 209- 318-8053 <br /> Fax Number:Lj- <br /> PERMITTING CONTACT(if different from applicant/operator above): <br /> Contact's Name:Title: Company Name: <br /> Street-._P.O.Box: City: <br /> State:Zip Code: Telephone Number: �- <br /> Fax Number:Lj- <br /> INSPECTION CONTACT: <br /> Contact's Name:Title: Company Name: <br /> Street: P.O.Box: City: <br /> State:Zip Code: Telephone Number: LL- <br /> Fax Number: ()- <br /> CC:STATE OR FEDERAL LANDOWNER(if any).- <br /> Agency: <br /> Street: <br /> City: <br /> State_Zip Code: Telephone Number: (1- <br /> CC:STATE OR FEDERAL LANDOWNER(if any): <br /> Agency: <br /> Street: <br /> City: <br /> State:,Zip Code: Telephone Number: U- <br /> -3 - <br />