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<br /> <br />-2- <br />3. Address and Phone Number of 3~'U~ lit <,J~,Sr E+5e.~ (.uL}~,4J~C-HN ~ '• i>c537- 69-3'7-, <br />Local Offices 7S~1t~ Lc.~c~' L~U~~z~ ~i~. ~y-1~ , LcwEC. rl~l,'D, C_C: <br />': 4'c~37 4%E7-~-i~- <br />4. Address and Phone Number of 3ic0~~7z, 1.:.'C=S' C~S~=/ti'/~c~I~C'72, LC'6'c~ti'-U, (O ~(~'7. <br />~C6j) :fly <br />General Offices <br />'"]`; lc' i.uCSr' CTy R ~ -~u-r+ ~ c nvc=~~+n,~D , e c7 ca~7-~nr9`f <br />5. Name and Phone Number of Person LIEnn SJ~c~,t~~C~ ~(`^~-tci~y <br />Staff Members Should Contact IX(V~, ~LCjC.~YI (p(_ I -~~43 <br />6. Owner(s) of Record of Affected Land GeV1e FvPevnGLc:~ <br />(surface area) (If more than 2, list below) <br />°I 7. Owner(s) of Substance to be Mined ` <br />(If more than 2, list below) Gene rV'e~mlth <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.) IBC+CIi~+ZEo~ ~~ ~C.~.~ <br />9. Type of Mine and Substance to be Mined <br />(Specify underground, open pit, <br />quarry, etc. & substance(s) to ~~lCl~~~'J _ SCIr'~c)S~;~t~ <br />be mined) <br />10. General Location and Elevation 1~;,1^ ~DX~ rrtC~~-c? `~~~ E'.IEI.~I'I-ilVl S~,Z.50-~ <br />(Miles & direction from nearest ~I~ m(IeS (gyp/~I,i/PS'~ -~VGn~ (.~;~(Q ~ ~i,f'-i <br />town & approximate site elevation) ~ ""'t; <br />a,~ ~.,;ies 5~~~-t-, e~~ Mas~rl~~iie. <br />11. County (_,A (ZI M1= rL <br />12. Acreage of Affected Lands <br />(Total surface acreage to be ~y,~ 5 <br />included in permit) ~ G~ <br />13. Application Fee (See applicable <br />Rule to determine amount) l-(~ .~ V <br />