_PERMIT FILE - M1985100 ‎(3)‎

• Permit No: M1985100
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT 110 & SPECIAL TEN DAY 111 PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

-z-
8°u llL
3. Address and Phone Number of Saa~~~c,F~~-~-O~C~' ~ g~o~3
Local Offices 52 3 -4321
4. Address and Phone Number of
General Offices SgME a s aoovc
RoGe.aT E•1-lu.nPN,eey
5. Name and Phone Number of Person• ga x i~G
Staff Members Should Contact ,~Pa~NSF•E'-o~Lec~ 8io~a
SZ3-(0292
6. Owner(s) of Record of Affected Land Pone.z~~ rnnnUA2~r /„(a«nc.,.- f F6+ZUA•l.a"-Y
(surface area) (If more than 2, list below) o`u yeas °Ce""'.`~°"°~O BrL NI/WF-D
7. Owner(s) of Substance to be Mined
(If more than 2, list below) Sd~z Asad~v~
8. Source of Legal Right-To-Enter
(Indicate what type of proof is
included in EXHIBIT G - lease,
deed, notarized letter, etc.) L ,~-rrerL
9. Type of Mine and Substance to be Mined
(Specify underground, open pit,
quarry, etc. & substance(s) to
be mined)
O 17 iv.N 47~T'
l31.A+c.~S /~25T o~C.vMyo,GG.tiaoo~ 2r.nic.r~5
10. General Location and Elevation SouTH duo y M~c-E i.Jm3-- L° ~~A~~ ~.r ata
(Miles & direction from nearest Z
town & approximate site elevation)
4SGo ~~f. VAT~O A/
11. County
$a~a
12. Acreage of Affected Lands
(Total surface acreage to be
included in permit)
8.SZ9 g~,cc~.s
13. Application Fee (See applicable
Rule to determine amount)