PERMFILE40988

• Permit No: M1977098
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT AND SPECIAL 10-DAY PERMIT APPLICATION CHECKLIST
• Media Type: D
• Archive: No

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MINED LAND RECLA*iATIO'.V
LIMITED ID(PACT AtdD SPECIAL 10-DAY PERMIT APPLICATIOV CHECkZIST
File tdo.77Tgp Name S1 ~UPr' ~anc.~i lei -~- Date of Filing (Completeness):
ITEM COi~LETE ADEQUATE COMAfEIdTS
Application Form
1. P1ame of operation
6
2. Name of applicant/operator ~ /~~
3. Address & phone (local offices) /
4. Address b phone (general offices) /
5. Person to contact ~
6. Surface owners /
7
7. ALineral owners ~// /
8. Type of mine/substance ~
9. General location S elevation
10. County ~
11. Acreage 6/~~
12. Fee ~
13. Present land use 6/~ ~1
7
14. Proposed future use ~//L
15. Signature C (~,
Maps and Exhibits
1. Exhibit A - Legal description /
6/~~
2. Exhibit B - Alining plan
3. Exhibit C - Map b
4. Exhibit D - Sdildlife, (dater Resources,
Vegetation and Soils infor-
mation
L//~
((J

5. Exhibit E - P.eclamation plan /
6 /~~