Laserfiche WebLink
<br />R. ADMINISTRATIVE INFORMATION: <br />1. Permit Number: <br />2. Operation Name: <br />z- <br />~x~~~ ~_ <br />3. Current Permitted Operator. <br />Contact Person: (1~9 ~ ll ~~~i~(~ ~ _ <br />Company Name: <br />street: ~~ ~~,L-~l~ <br />city: L~~4, ~~ <br />State: 11a!~x,~6'1 Zip Code: ~~ iy/~ <br />Area Code: Telephone: <br />4. Successor Operator: <br />Contact Person: ~ /'!/7 , ys //jJ~ri/_~~~(/~,Z <br />Company Name: <br />sheet: ~~, E~~,1[ r'd~~' <br />City: ~ ~~(~ <br />._ State: / [~I~~'> Zip Code: ~`~~ <br />Area Code: e ©3 Telephone: g'~._~ _ ~ C~ `d'~ <br />IRS Tax ID No. or Social Security No.: . rj oZ 3 - ~~f ~~.~ 7' <br />5. A~pGcation Fee: $100.00 for Hard Rock operations; $125.00 for Conshvction Materials operations <br />Make check payable to the Division of Minerals and Geology <br />