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Email Address * <br />Enter a valid email address in this field to receive a confirmation e-mail. <br />mountaingirls111 @gmail.com <br />Your Phone Number* <br />Used only to follow up. <br />9704011349 <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 Fv Nearby Resident <br />Adjacent Land Owner Concerned Citizen <br />Government Agency 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. This form is not intended for reporting of possible violations or illegal activity. Please be as specific <br />as possible. <br />Comment/Objection Narrative * <br />Please see attached letter of objection. <br />Permit Number* <br />Enter valid letter and then numbers, for example M1977999, M1999777UG or C1981201. <br />M1990057 <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 />Lake <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 />9 Yes No <br />