Fillable Cancellation of Permit (West Virginia Division of Natural Resources)

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Cancellation of Permit (West Virginia Division of Natural Resources)

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WVDNR OLS REV 1/2020
Cancellation of Permit
Permitee Name: _______________________________________________________________________
Permit Number: _______________________________________________________________________
Person Authorizing Cancellation: __________________________________________________________
Cancellation Date: ______________________________________________________________________
Reason for Cancellation : ________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please Send this Form to :
Division of Natural Resources
Office of Land and Streams
324 4
th
Avenue, Room 200
South Charleston, WV 25303
OR
Via E-Mail at:
DNRLandandStreams@wv.gov
If you have any questions, please contact our office (304)558-3225
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Cancellation of Permit (West Virginia Division of Natural Resources)

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Completed 1 November 2020

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