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4/7iT <br />• <br />@Q`lED Ldv")i R°CLAZL4TIOit <br /> <br />LIHITED L`IPACT ailD SPECIAL IO-DAY Pzi2idIT AP°LIGaTIO:i C°_EC:a,IST <br />File `to~~ `lame L'/'~~~-~- G~c~..-.~,- Date of Filing (Completene=cs): <br />I~ CO~LETL•' aDEQIIAT'c C0:2SEITS <br />Aaalicacion Fora <br />1. Yame of operation <br />2. vase of aaalicaac/operator <br />3. Address phone (local offices) <br />4. address & phone (general offices) <br />5. Person to contact <br />5. Surface ocmers ~ ~'' ~ ~ <br />7. ~iiaeral o~aaers <br />8. 'Tune of ciiae/substance ~ <br />9. General location ~ elevation ~ , <br />/i <br />G <br /> <br />Z0. County , ~ ~ <br />w" ~ <br />I <br /> <br />LL. Acreage <br />I <br />I G~~ mo- <br />i2. r-ee I~ <br />13. present Laad ~:se ~ ` <br />! ~------~ - ~ <br />i <br />14, proposed fntu:e use ~ <br />i <br />L.G. Signature <br />.aas and Exhibits <br />L -csaibit .~ -Legal desc:ipt_on _ /r <br />~/ <br />2. Exhibit B - _.iaiag olaa + I <br />3. =-:aihit C - :aa ~ <br /> <br />~. E:s: ibit D - 'dii3life, [dater Resources, <br />7egetatioa and Soi:s_afcr- <br />^a taan <br />r <br />/ i <br /> <br />I <br /> <br /> <br />S. °zh.;.bit - ?eelamation plan i <br />i <br />I I <br />