Laserfiche WebLink
Operator(If Other than Permittee): <br /> Permittee Representative: Marcy Brossman, County Administrator <br /> Certified Mail # 7021 2720 0002 0894 4208 <br /> In accordance with Rule 4.17.1(2)the Operator shall include the names,addresses and phone numbers of all <br /> owners of record to the affected land. Please attach additional sheets for this information if required. <br /> Name Address Phone Number <br /> C/O Osborn&Bennett,816 Congress Ave.,Ste. 1620, <br /> KICT LLC Austin,TX 78701-2889 512-476-3529 <br /> In accordance with Rule 4.17.1(4),if requesting a partial acreage release the Operator or their agent MUST sign that <br /> they have complied with the following statement: "All applicable portions of the Reclamation Plan requirements <br /> have been satisfied in accordance with these Rules and all applicable requirements under the Act." <br /> C 6�I k e�� 4/23/2025 <br /> Sig ture f Permittee, Operator or their authorized agent Date <br /> Important: In accordance with Rules 4.14.2(a) and 4.17.10) This release request must be submitted to the <br /> Division via certified mail and separate from any other correspondence to the Division. <br /> MineralsReleaseRequesffom 20Sep2017 <br /> Page 2 of 2 <br />