PERMFILE40385

• Permit No: M1995034
• IBM Index Class Name: Permit File
• Doc Date: 5/2/1995
• Doc Name: APPLICATION FOR LIMITED IMPACT OPERATION 110 RECLAMATION PERMIT
• From: DANIEL M RUSSELL
• To: DMG
• Media Type: D
• Archive: No

• t
PHRMIITING CONTACT (if different from applicant/operator above)
Individual's Name: Title:_
Company Name : ~~~ t:
Street: / ,
a
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
CC: STATE OA FEDERAL LANDOWNER (if anv)
Agency:
Street: ~
City:
State: Zip Code:
Area Code: Telephone:
CCi STATE OR FEDERAL LANDOWNER (if am)
Agency:
Street: A / ~
City:
State: Zip Code-
Area Code: Telephone:
11. Primary future (Poet-m+^~++g) lead use (check one):
Crop3aad(CR) _ Pastureland(PL) General Agriculture(GA)
Ranyelaad(RL) _ Forestry~(PR) = Wildlife Habitat(WL)
Reeidential(RS) Recreation(RC) Industrial/Commezcial(IC)
_ Developed Water Resources(WA) _ Solid Watts Disposal(WD)
12. Primary Ares ntnt land use (check one):
_ Cropland(CR) ~ Paetureland(PL) General Agriculture(G7U
~ Raayelaad(RL) _ Fozestrx(FR) _ Wildlife Habitat(WL)
_ Resideatial(RS) _ Recreata.on(RC) Industrial/Commercial(IC)
_ Developed Water Resourcee(WR) _ Miaing(TIIQ)
13. if this operation will use designated chemicals, or will result, or presently has
acid mice drainage - you cannot use this application form. You must submit a either
a 110d or 112d application form for Designated Mining Operations.' In either case,
you must list any acidic or toxic-forming materials, exposed or disturbed as a
result of the mixing operation, sad whether the operation rill result Sa or
presently has acid mine drainage:
Description of Conversion:
If you are converting as existing operation, provide a brief narrative describing the
proposed change(s).
Mane ~ 8xhibits:
Submi t two (2) complete, unbound copies of the follori.ng application exhibits:
y6.3.1 8ffiHIT A - Legal Description and Location Map -g7TAG}fEL~ ~JLAT-
.- 6.3.2 B~IIHIT 8 - Site Description
6:3.3 S~iIHTT C - Mining Plan
6:3 .f 87GgIHIT D - ReclBmatiaa Plan
t~6.3.5 SETT E - Maps
6.3.6 87G?~IT F - Liet of Other Permits and Licensee Required