APPCOR10905

• Permit No: C1981047
• IBM Index Class Name: Application Correspondence
• Doc Date: 8/25/1977
• Doc Name: LIMITED IMPACT AND SPECIAL 10 DAY PERMIT APPLICATION CHECKLIST
• Media Type: D
• Archive: No

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MINED LAPID RECLAMATION ~/~ % G/< -
LIMITED 7SSPACT AND SPECIAL 10-DAY PERMIT APPLICATION CHECKLIST
File No. '7G-G NameStJNiLo~uBR ~jS/ernGJ Date of Filing (Completeness):
ITE."i COMPLETE ADEQUATE COMPSEidTS
Application Form
1. Name of operation ~/LV~ ~/8~o~~r/~~
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Z. Name of applicant/operator ~_ L~•
3. Address S phone (local offices) ~- ~_
4. Address & phone (general offices) ~ L~ S/~~'JL ~l S ~
5. Person to contact ~ '
6. Surface owners ~! ~._
7. itineral owners
" ~ .~ -
8. Type of mine/substance ~. ~~_
9. General Location & elevation _
lo. county ~ (~ ~E~7A
11. Acreage (~~' [~- 9• Jr 9
12. Fee - ~~~
13. Present land use (~-
14. Proposed future use L_ Lr
15. Signature V L~

Maps and Exhibits
1. Exhibit A -Legal description

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2. Exhibit B - ;Sining plan ~ ~~
3. Exhibit C -Map ~- `~ -"
4. Exhibit D -Wildlife Slater Resources;
Vegetation and Soils infer-
oration '~
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~. Exhibit E -Reclamation plan rj~ LI'
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