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<br /> -z- <br />3. Address and Phone ~Jumoer of <br /> Local Offices <br />4. Address and Phone Number of <br /> General Offices - <br />5. Name and Phone tJumoer of Person Cu4hti~ ~~/G'NGi'~P~ Ch/'l O~~ti~/~'2 <br /> Staff idemoers Should Contact ~l,~dNf~ <br />~ c ~ri/ci' ~ <br />S.a ~ <br />~ ~- ~ ~~ <br />6. Owner(s) of Record of Affected Land /JC'Gl;ti'~/'C' ,/~/,,`NC ~~11~1°Yfs"% <br /> (surface area) {If more than L, list below) <br />7. Owner(s) of Substance to be i•1ined ~(JPCG,/1+~GFP /~ ~Nd ~•~ ~/~ ~c-u ~,p, <br /> (If more than 2, list below) ~~ <br />r3. 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 />9. Type of ~~line and Substance to oe Mined -t- <br />Q,D~^l P/ / <br />open pit <br />(Specify underyround /' <br />Gra <br />•~' l <br /> , <br />, <br />quarry, etc. & substance(s) to <br /> oe mined) <br /> 3 - ~~~~~~ s ~u~s ~ U~fs ~~ <br />lU. General Location and Elevation <br />fr <br />ear <br />(Mil <br />ecti <br />t ~ <br />& di <br />~ <br />~" / <br />~ ~~ <br /> r <br />on <br />om n <br />es <br />es <br />xac, c <br />c u .~/ y <br />C <br /> town & approximate site elevation) <br />~ <br />~~ <br />~' ~f <br /> t <br />5 S <br /> <br />1 l . <br />County ~~r i ~ ~ E/y NE;fy <br /> <br />12. Acreage of Affected Lands <br />(Total surface acreage to be <br />~ <br /> C /' e 5 <br />included in permit) <br />13. Application Fee (See applicable ~ ~ „~ 5J <br /> Mule to determine amount) <br /> `1 <br /> <br />