Laserfiche WebLink
<br /> _2_ <br />3. Address and Phone iVumoer of q-~O ~ D <br />~ <br /> Local Offices <br />~ <br />Dve?A ?1~ <br />- ~7 <br /> <br />4. Address and Phone Number of <br />l <br />~~ ~ <br />~ ~ <br /> Genera <br />Offices -' <br />5. Naine and Phone rlumoer of Verson ~ ) ~ ~~~.-~./` ~~S <br /> Staff Plemoers Snould (intact ~ z ~ /I <br />~~~- Y <br /> <br />o <br />f R <br />O <br />d <br />f Aff <br />~ ) ~~ ~ ~~~~~~~ ~ t ~ ~~/ <br />5 <br />e <br />~~~~~ <br />1~ <br />. wner(s) o <br />ecor <br />o <br />ected L anu .. lJ <br />- <br />-~ <br /> (surface area) (If more than 2, list below) <br />1. Owner(s) of Substance to be itilin~d \I ~~~~ <br />~~~ 1 I <br />t' ~~{~ <br />~ <br /> (If more than 2, 1 ist belo~,a~~ ~ <br />F i I--~J~- <br /> , <br />n. Source of Legal Right-To-Enter <br /> (Indicate what type of proof is ~~~"v <br /> included in EXHIBIT G - lease, <br /> deed, notarized letter, etc.) <br />9. Type of Mine and Substance to oe <br />cif <br />(S <br />d <br />it Mined ~v~~,1~>r ~ <br />tT~i~ ~~ ~' ' <br /> y un <br />eryrounu, open f <br />pe <br />, <br /> quarry, etc. ~ suostance{s) to <br /> oe mined) <br /> <br />1~~. <br />Ueneral Location and Elevation <br />~~2;W ~Z;SV~Il4. S~• ~`t <br />~'t'I~ ~' <br /> (Miles iy direction from nearest ~ yv ^f ,n/~,• ~, /..n ~ -7 <br /> tuwn & approximate site elevation) <br />2 /Wl l LES ~~oU <br />~ ~ ie~ f~-(~,~ <br />11. t;ounty L A #~LA'~t <br />12. Acreage of Affected Lands <br /> (Total surface acreage to be ~ A C ~~~ <br /> included in permit) <br /> <br />13. Application Fee (See applicaole `~ 'r~ <br />® <br /> Rule to detannine amount) 1 <br /> <br />