PERMFILE40559

• Permit No: M1973007SG
• IBM Index Class Name: Permit File
• Doc Date: 4/1/1985
• Doc Name: APPLICATION WORKSHEET CHECKLIST
• Media Type: D
• Archive: No

Regular 112 Application
~ I(I IIIIIIIIIIIIIIII ~
MINED LAND RECLAMATION
Application Worksheet/Checklist „~~„~~s~~~~~~~ 7
NameJ~jr~,e/sc5o~ Ca ~~~ File No. 73
Compiete Filed Date _~~,/,~JgQ,I'
ITEM
COMPLETE ADEQUATE COMMENTS
Application Form:
1. Name of Operation
/
2. Name of Applicant/Operator ~/
3. Address & Phone (Local) ~
4. Address & Phone (General) ~/
5. Person to Contact ~/
6. Parent Corporation, if any ~.
7. Surface Owners /
8. Mineral Owners /
9. Source of Legal Right-To-Enter /'
10. Type of Mine/Substance Y/'
]l. General Location & Elevation
12. County ~
13. Acreage
14. Fee /
15. Present Land Use 1r
16. Surrounding Land Uses
17. Proposed Future Use ~ ~ ~`'"" ~` "' "~" ' `
h. ~,~,