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.~ <br />MIN III IIIIIIIIIIIII III 1N <br />ist <br />~IQT¢~Gt~r PlT <br />Regular 112 Application NameL'ou~~NExrp/n11NG ~N. File No.M~~6~~2-3 <br />Complete Filed Date ~, SEVt~14'~'~ 19g~ <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of Operation <br />~ Y <br />/` <br />2. Name of Applicant/Operator Y <br />/\ ~( <br />/` <br />3. Address & Phone (Local) <br /> <br />4. Address & Phone (General) L~ vE~a ~ D <br />5. Person to Contact \~ <br />J\ <br />6. Parent Corporation, if any <br /> <br />7. Surface Owners X / ~ <br />8. Mineral Owners .~ " <br />9. Source of Legal Right-To-Enter ~,,~ <br />1` <br />10. Type of Mine/Substance X <br />11. General Location & Elevation u <br />/` <br />12. County V <br />/\ <br />13. Acreage <br />14. Fee \, <br />15. Present Land Use ~ v <br />/~ <br />16. Surrounding Land Uses k <br />17. Proposed Future Use /u~?uui»+gpr ~^~~ Prr-!%' <br />+,,:..w " <br />WnVUrc Il~n:yr+~r <br />