Laserfiche WebLink
-2- <br />II. ADMINISTRATIVE INFORMATION: <br /> A <br /> <br />1. Permit Number: ~/ <br />~ ``~~ <br />' ` ~ ~ 1 U ~ ZU <br /> <br />2. Operation Name: i~ <br /> <br />3. Current Permitted Operator: <br />Contact Person: <br /> <br />Company Name: <br /> <br />Street: <br />city: ~, p ~ i 'fc ~ ~. ~ . <br />State: ~ 3 3 <br />Zip Code: <br />(~ <br />Area Code: Telephone G <br />` <br />: ~~ 3' o ~ b~ ~ ~dG <br /> <br />4. Successor Operator: <br />Contact Person: ~ 1..6 (~ ~ 5 <br /> <br />Company Name: ~.-l ~ Sd~W,~ ~ I:TK-~(V(3Z. ~• <br /> <br />Street: / <br />~~ <br /> <br />City: ~~ <br /> <br />State: ~ Zip Code: ~?~ <br />Area Code: ~ Telephone: ~1 ~o - 9-~ <br />IRS Tax H) No. or Social Security No.: ~ - ~ 6 uo24'~ . <br />5. Application Fee: $100.00 for Hard Rock operations; $125.00 for Constmcfion Materials operations <br />Make check payable to the Division of Reclamation, Mining and Safety <br />