GENERAL46598

• Permit No: M1978332
• IBM Index Class Name: General Documents
• Doc Date: 12/4/1992
• Doc Name: TWO ACRE LIMITED IMPACT OPERATIONS 110 1 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

-Z-
9
Correspondence Information: N ~ ~- ~ " '" C~~
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
Telephone:
Zip Code:
INSPECTION CONTACT
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State: Zip Code:
Area Code: Telephone:
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State:
Zip Code:
Area Code: Telephone: