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M <br />~'•' t <br />~, <br />~~ <br />~~ <br />-2- <br />3 Address and Phone Number of ~` ~~~`~" ~`~1~'``' (~os~ ~ ~•/- o~~'y <br />. <br />" Local Of fices F:°o !1 ~ ~ F• ,'c ~~t-;. <br /> %AO ~. vl rnlr..,;0. T~~.ve. <br />Gn N <br />~~;fn•~, Gb f~rJ ~o <br />4. Address and Phone Number of <br /> <br />General <br />Offices <br />~°.••= ,,, <br />"` ~ bov°- <br />5. Name and Phone Number of Person "~~ ~ ~ F,~ L r.,~.,C~ <br /> Staff Members Should Contact f-,~. <br />.+ <br />... .,i rn C~,;C nG,G. <br />/~ <br />J" Pnp~~c.\~ Gr.}~nJ <br />r <br /> (-gin-=l (-~~//-/`//D <br />6, Owner(s) of Record of Affected Land Po.y~ Toro mop has <br /> (surface area) (If more than 2, list below) " c°., ,.r . F..,~~ y, <br /> c.~~~~~r•:.,, c,, <br />7. Owner(s) of Substance to be Mined <br />(If more than 2, list below) <br /> <br /> <br />8, Source of Legal Right-To-Enter <br />(Indicate what type of proof is <br />included in EXHIBIT G -lease, <br />deed, notarized letter, etc.) <br />Tai e,,,orn. r~~. ,. n, ~.., ree n, ~r~{ <br />A <br />4, Type of Mine and Substance to be Mined <br />(Specify underground, open pit, <br />quarry, etc. & substance(s) to <br />be mined) <br />10. General Location and Elevation <br />(Miles & direction from nearest <br />town & approximate site elevation) <br />11. County <br />12. Acreage of Affected Lands <br />(Total surface acreage to be <br />included in permit) <br />13. Application Fee (See applicable <br />Rule to determine amount) <br />~P~~~ Pit <br />Sa~~ a,.,~%' Grp-~e~ <br />frpProT:. ~~-.o Wily '/i nnmfle wns~ <br />o~ Gou 12 ~"~: ~~s Co ~o i`o-f11.o IJorth ~ 4S 50 <br />' " ~J <br />G~.,~~~,s°r~ - <br /> <br />,• ,~ <br />