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-~. .. <br />6 ,y~~r 7~ <br />4/77 • MINED LAND RECLAPIATION • /'/ <br />Regular (112) Permit Application Checklist <br />File No. ~ ~ ~ Name /~p ~',y„rj ~~ Date of Filing (Completeness) <br />ITII4 COMPLETE ADEQUATE COI4IENTS <br />Application Form <br />1. Name of operation <br />2. Name of applicant <br />3. Address b phone (local offices) ~ <br />4. Address & phone (gen'1. offices) <br />5. Person to contact <br />b. Parent corporation {if any) ~/ <br />7. Surface owners <br />8. Mineral owners ~/ <br />9. Type of mine/substance ~/ <br />.0. General location S elevation / <br />.1. County ~/ ,. <br />.2. Acreage / U~i~ <br />.3. Fee <br />A/ <br />.4. Present land use ~ . <br />.5. Surrounding land uses / <br />:6. Proposed future use y/ ~~~~,~ T C9'^'/ <br />.7. Other mining permits ~/ <br />.8. Signature v~ <br />.9. Prohibited Lands Statement rr <br />2faps 6 Exhibits <br />1. Legal description <br />/ <br /> <br />2. Index map / <br /> <br />3. Pre-mining & mining plan map pP~e.~ <br />'v Z .r.-e.,a <br />~~~ 3 ~~. /e ?,y o r~ (moo <br />/ <br />4. Mining plan - a) timetable `~ r;/ c'~t~%' 7 <br />- b) depth b thickness of ore / <br />