No permission is required for the following reasons:

1. The image file is a mechanical scan/photocopy of the original cover and does not qualify for independent copyright protection.
2. The photo and the rest of the book's dust jacket were published without a copyright notice and, therefore, are ineligible for copyright protection.

The collection Self-Portrait in a Convex Mirror was published in 1975; the book itself carried a copyright notice (seen here in a scan of the book at archive.org) and its contents remain copyrighted. However, the first-edition dust jacket did not carry a separate copyright notice. According to The Compendium of U.S. Copyright Office Practices: Chapter 2200, § 2207.1(C) at p. 15:

"A notice of copyright on the dust jacket of a book is not an acceptable notice for the book, because the dust jacket is not permanently attached to the book. Likewise, a notice appearing in a book is not an acceptable notice for the dust jacket or any material appearing on that dust jacket, even if the book refers to the jacket or material appearing on the jacket."

To verify the lack of a copyright notice, high-resolution photos of other parts of the same edition's dust jacket can be seen via WorthPoint, Freeman's Auctioneers & Appraisers, and Biblio:

• Back cover;
• spine (and front cover again);
• left flap (alternate view); and
• right flap.

Keep in mind that the pre-1989 requirements for copyright notice were highly formalistic and, other than a few enumerated exceptions, required these three elements:

1. "The symbol © or the word 'Copyright' or the abbreviation 'Copr.' or an acceptable variant such as "(c)"
2. "The year of first publication for the work"; and
3. "The name of the copyright owner, or an abbreviation by which the name can be recognized, or a generally known alternative designation of the owner."