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4/71 --- ---- --- '~~~ [~ ~ ~~'- 7~ <br />III IIIIIIIIIIIIIIII ~PfINED LAND RECLAMATION ~ ~` ~ <br />rr~~sss c2AAe~ular (112) Peptmit Application Checklist <br />Pile Io. 7/'~~~ Name/1.~'~. '• =• /`-fir /~- ~-y Date of Filing (Completeness) <br />ITEi•1 ~~Iv/V j raJ~/ ~; •' ~-' ,' COMPLETE ADEQUATE COT4fENTS <br />Application Form <br />1. :lame of operation <br />_~- <br />-~ <br />2. \ame of applicant c' <br />s. Address fi phone (local offices) ~~ L^ <br />4. Address fi phone (gen'1. offices) ~' L, <br />5. Person to contact ~ ` ~ <br />6. Parent corporation (if any) ~ - <br />7. Surface owaers f ~ /~ <br />3 . ?fineral owners ~- ~" <br />i / ~' <br />9. Type of mine/substance i !~' j~vG;-L//f,7,'-za ' <br /> <br />0. General location fi elevation ~ <br />L. i <br />r <br />.l. county ~ t~I , <br />~_ f <br />I <br />.2. Acreage Gam-- ~ '-- <br />~` <br />3. Fee ~ I L- ~ ~5/ -- "` C <br />.4. Present land use ! <br />L~ ~ <br />~ <br />.6. Surrounding land uses r --' L-- <br />.6. Proposed future use •-- <br />7. Other mining permits ~ ,-~d.~n.'%:-: <br />8. Signature f - <br />.9. Prohibited Lands Statement ~~ ~ <br />''aps & Exhibits <br />1. Legal description <br />2. Index map ~~ Lam- <br />3. Pre-mining fi mining plan map <br />i <br />4. Paining plan - a) timetable ~ <br />~ <br />~~ <br />- b) death 6 thickness of nro i <br /> <br />~ G.- >`~~ c- ~; <br />body ~YJ%1.-';.' <br />