Land use permit

Mixed

Department of Natural Resources · Division of Mining, Land and Water · 102-1084A (Rev. 9/21) · AS 38.05.850

Applicant

Form 102-1084A page 1

LAS # (if known) (optional)

Name

Date of birth (optional)

Doing business as (optional)

Business license # (optional)

EIN (optional)

Mailing address

Contact person (optional)

Email address

Phone

Applying for a corporation

Yes