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Y C • <br />-2- <br />3. Address and Phone Number of <br />Local Offices <br />• <br />14176 ! Tallar ~ 7~'-Q-3~o6 -- <br />4. Address and Phone Number of <br />General Offices <br />5. Name and Phone Number of Person uq~o,~/I L`~~~A, '~~.3~,76~ <br />Staff Members Should Contact I~0.~gd G~are ~ b~}3~~6 <br />6. Owner(s) of Record of Affected Land <br />(surface area) (If more than 2, list below) <br />7. Owner(s) of Substance to be Mined <br />(If more than 2, list below) <br />7'hG C ld ~ ~ C ova <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.) <br />9. Type of Mine and Substance to be Mined <br />(Specify underground, open pit, n t <br />quarry; etc. & substance(s) to ~fC~~e. ~M~OM ~AIIC <br />be mined) ~ d <br />Qr. bta~.l~fd rl <br />10. General Location and Elevation (~` ~"ii~s ~qt'~ O~ r~O1Y6dgh~' <br />(Miles & direction from nearest <br />town & approximate site elevation) <br />11. County <br />T~11~ <br />12: Acreage o'~ Affected Lands <br />(Total surface acreage to be <br />included 'in permit) <br />bP~ <br />Q /~ i <br />7. I rlf.P~w~ ^' a~ oo+ <br />13. Application Fee (See applicable <br />Rule to determine amount) <br />