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4/77 III IIIIIIIIIIIIIIII ~D LAND RECLAt1ATI0N <br />Regular (112) Permit Application Checklist <br />File 2Io. ~g- 5 Name ~DC,I'la5f~ C~m~aruY Date of Filing (Completeness) <br />ITEi•1 COMPLETE ADEQUATE COZ•IIMENTS <br />Application Form <br />1. i4ame of operation <br /> <br />2. .lame of applicant <br />/ nn ,n, <br />I 1.1J • ~~ ~' NO • ~ <br />3. Address ~ phone (local offices) <br />4. Address b phone (gen'1. offices) ~ <br />5. Person to contact ~ <br /> <br />6. Parent corporation (if any) <br />~/ i <br />7. Surface owners ~/ <br />3. Piineral owners ~/ <br />i <br />9. Type of mine/substance <br />0. General location b elevation ~ <br />1. County <br />.2. Acreage ~ <br />3. Fee i ~ I ~ Jh61.lQd ~E ZbO.Cb <br />4. Present land use <br />.5. Surrounding land uses i ~/ <br />.6. Proposed future use ~/ <br />7. Other mining permits <br />i <br />.8. Signature <br />.9. Prohibited Lands Statement ~ ~ <br />:taps b Exhibits <br />1. Legal description <br />2. Index map ~/ <br />3. Pre-mining 5 mining plan map ~/ <br />4. Mining plan - a) timetable I ~/ <br />- b) depth 6 thickness of ore ~ <br />i j <br />~ <br />ooay <br />