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7/78 + aPPL1c;:Tlan C:=c::<LI~T . III III III~IIIIIIIII <br />LI4ITED Ir,PACT (110) n rIAHE F1Lc ?~~ll <br />SPECIAL 10-DAY (I11) _ COltPLET"c (FILED) DATE ~(~ ptg /~~'Z <br />ITEH <br />COMPLETE ADEQUATE COnnE"1TS <br />Aoolication Form: <br />1. dame of operation <br />f~ <br />;, l <br />~M <br />2. Yame of applicant/operator / <br />'/ / <br />/ I , I n~ C~ 4 , <br />~J.~JG~e-v ~~r~C <br />3. Address E phone, Iecal / <br />/ / I <br />4. Address 8 phone, general / <br />`/ I~ <br />5. Person to contact / I~ <br />6. Surface owners V <br />/ / <br />/ <br />7. nineral owners I ~ ~ <br />~ <br />8. Source of legal right-to-enter I / I <br />/ ~ <br />?. Type of minelsubstance I ~ I / <br />, <br />/ <br />10. General location ~ elevation ~ ( <br />/ <br />/ <br />11. County ~ I ~ <br />12. Acreage '. ~ ~'1+~y~(CP.Ld/ 5 <br />h~ <br />13. Fee ~ / <br />14. Present land use / <br />l <br />15. Proposed future use Z / I <br />V ` <br />i <br />16. Signature / ~ <br />V ~ <br />Hails and Exhibits <br />EXH131T A - Legal Description <br />/ _ _._ <br />EXHIBIT 8 - Mining Plan / <br />/ <br />EXH 131 T C - clap l~ Y- . ' <br />E:tH SIT D - 'ai ldl i fe 'rater Resources; <br />Vegetation, Sails Information / <br />~VV/ <br />