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Form Sm 6 2017-2023
Is
relative to mean sea level
feet
COUNTY
MAILING ADDRESS
No attachments will be accepted. Legal description of permit area:
1/4
1/4
Section
Township
Range
Telephone
Proposed subsequent use of site upon completion of reclamation
Signature of company representative or individual applicant(s)
Name and title of company representative (please print)
Date signed
TO BE COMPLETED BY THE APPROPRIATE COUNTY OR MUNICIPALITY:
Yes
Please answer the following questions ‘yes’ or ‘no’.
1. Has the...
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