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III IIIIIIIIIIIIIIII <br />999 <br />Initial~• CALF <br />Permit Worksheet <br />Permit Uate: y,z-~~:;r , <br />Permit Numuer: /n- XS- 003 <br />Operator ~. C~ <br />Address: ~ ;Q /~ i/c <br />eQ ru/zi ~ 8 C O // <br />Contact Person: > (~',s,,lFa.,..F: / f} sow. .~ S. S .-. ~w <br />PitjMine Name: ~ } <br />Material Extracted: Sang ~ ,7< <br />Board Dates: F r , -~ X /9 S <br />County: 716e~f- Acreage: <br />Legal Description: W' av'/ /5 C NW'/ ' <br /> ~ a (~ s 6 a <br /> eat ~ <br /> <br />Na Rider: <br />Rider: <br />Rider Information: <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />,. <br /> <br />5,,. !c I / 7 <br />Gir~.,t ~ Co <br />Uoz3/ <br />P ~.~ <br /> <br />Jac. No. 5728 <br />