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7/78 ~ APPLICATION CHELKL I ST III III I IIIIIIIII III 135 <br />LIMITED IMPACT (110) X NAME l3~ae .7~ /t'1-^ -. hlLt K <br />SPECIAL 10-DAY (111) _ COMPLETE (FILED) DATE ~ ~N;~ 7 I `/~o~ <br />---------------------------------------------------------------------Z--1------------- <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of operation <br /> <br />2. Name of applicant/operator <br />3. Address b phone, local <br /> / <br />4. Address & phone, general <br />5• Person to contact <br /> x <br />6. Surface owners <br />7. Mineral owners <br />8. Source of legal right-to-enter <br />9• Type of mine/substance <br />j~ <br />Sc; <br />/ <br />I <br />10. General location ~ elevation <br /> 'ti.. <br />Il. County >~ <br />12. Acreage <br /> ~ ~- <br />13. Fee ~/ ~G1«~ ;, w~rvi <br /> /` K6 # N GNC~r` <br />14. Present land use \ <br />15. Proposed future use <br />\ -. <br /> <br />16. Signature <br /> <br />Maps and Exhibits _ <br />EXHIBIT A - Legal Description <br />EXHIBIT B - Mining Plan <br />EXHIBIT C - Map <br />J / <br />EXH IBIT D - Wildlife, Water Resources, <br />a <br />y <br />Veget <br />tion, Soils Inl <br />ormation <br /> <br />