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4/77 <br />MINED LAND RECLAMATION <br />Regular (112) Permit Application Checklist <br />File :90. 7-3G Name MA,,~(;~, Mrov,E9i-~(a S,/,« Date of Filing (Completeness): <br />Q ~ y <br />ITEi~1 COMPLETE ADEQUATE C0i`II~SENTS <br />Application Form <br />I. :lame of operation <br />//- ~•, <br />' /lJ~ <br />2. ;lame of applicant !/ <br />3. Address ~ phone (local offices) <br /> <br />4. Address 5 phone (gen'1. offices) i <br />5. Person to contact <br />6. Parent corporation (if any) <br />7. Surface owners <br />8. Plineral owners ~ <br />i <br />9. Type of mine/substance <br />.0. General location fi elevation <br />i <br />.1. County ~ <br />I <br />2. Acreage ~ <br />.3. Fee <br />1 <br />.4. Present land use ~ r/' <br />.5. Surrounding land uses ~ / ~ <br />.6. Proposed future use ~ ~ <br />.7. Other mining permits <br />.8. Signature ~ <br />9. Prohibited Lands Statement / <br />!/ <br />'laps b Exhibits <br />1. Legal description <br />/ <br />z-~~~~ <br />2. Index map <br /> <br />3. Pre-mining fi mining plan map <br />~ ~`.°` ~`vs---~~G <br />~.~~ ~w~P.~-"~ <br />4. Paining plan - a) timetable <br />- b) depth 6 thickness of ore ~ <br />i i <br />body <br />