Laserfiche WebLink
<br />u <br /> <br />-z- <br /> <br />~~7- ~l ~~ <br />3. Address and Phone Number of //~~ <br />Local Offices ~~ 1_'~~ ?, ' Z ~Y Ufr 5 (_ i~/~' ~~~c; r~G <br />>> <br />4. Address and Phone Number of <br />General Offices <br />5. Name and Phone Number of Person <br />Staff Members Should Contact <br />P.ti't~lr <br />6. Owner(s) of Record of Affected Land <br />(surface area) (If more than 2, list below) <br />~^UU~~prP ^1 <br />~PCr'd5r'a <br />61~Y ~ <br />~ ,~-~(vi~~ ~v~~Xr~r~r''1 <br />7. Owner(s) of Substance to be Mined `, <br />(If more than 2, list below) ~`a~o~~ aS ~ 1 ~~~ <br />8. Source of Legal Right-To-Enter <br />(Indicate what type of proof is <br />included in EXHIBIT G - lease, <br />deed, notarized letter, etc.) C_I~~ <br />9. Type of Mine and Substance to be Mined ~ . 1 <br />(Specify underground, open pit, ~( v ~ .Y.~,, •'~' `'~ r ~j~r•''~ <br />quarry, etc. & substance(s) to (_ V Y <br />be mined) <br />~~ ~~rlt' i~J?STS ~,~~a5v,~,,,rry .~/a <br />10. General Location and Elevation ;~ ~ <br />(Miles & direction from nearest <br />town & approximate site elevation) 7' ~ ~5 ~ ~r <br />-l~I~'~c~lrUvi <br />11. County <br />1 'Y"1 Ye1f ~ <br />12. Acreage of Affected Lands <br />(Total surface acreage to be <br />included in permit) 3 c} ~.r P ~~ <br />13. Application fee (See applicable 1'1 p ~ <br />Rule to determine amount) ~ ~ ~ <br />