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\~. <br />+/77 III IIIIIIIIIIIIIIII ~t.INED LAND RECLAMATIOR' <br />999 ~'~• <br />Regular (112) Permit Aoplication Checklist <br />File 210. ~- '1S Name ,~cY}4~•SoK L' ~,,.,~ Date of Filing (Completeness) <br />IT_Eif COMPLETE ADEOIIATE COHI'IENTS <br />Aoplication Farm <br />1. i4ame of operation <br />2. ;lame of applicant <br />i <br />3. Address fi phone (local offices) ~ <br />4. Address fi phone (gen'1. offices) ~ ~ ~ N'i <br />5. Person to contact ~ ~' <br />' <br />_ <br />5. Parent corporation (if any) " ~ <br />7. Surface owners ~' ~ <br />°. Piineral owners u <br />i <br />9. Type of mine/substance ~' <br />.0. General location fi elevation ~ " <br />.1. County ~ h <br />.2. Acreage '~ ~ <br />.3. Fee I " ~ <br />.4. Present land use ~ ~ ~ <br />.~. Surrounding land uses ~ <br />.5. Proposed future use ~~ <br />.7. Other mining permits ~• <br />.E. Signature " <br />.9. Prohibited Lands Statement <br />?taps fi Exhibits <br />1. Legal description <br /> <br />~„ <br />2. Index map ~ ~ „ <br />3. Pre-mining S mining plan map + Q <br />i <br />4. riming plan - a) timetable ~ , /~ <br />- b) depth fi thickness of ore ~ <br />body <br />