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/~(~ III III III IIIIIIIIII <br />LIYITEJ IMPACT (110) <br />SPECIAL 10-OAY (111) _ <br />1 Teti <br />~:PO1 IC''!C•`I C''= ':LIST <br />_' 83 -/ Y/ <br />C7NPLclc (r ll. D) DATc T L~ ~ 98' <br />COMPL= ~ E AOEQUAT_ CCN.NE`1 T S <br />Aocl icatien Fcrn: <br />1. `lame of operatics i fig/ I <br />2. `lame of applicant/operator <br />3. Address b phone, local <br />w. address 3 phase, generai { i <br />! <br />j. Persan Lo contact f ~ <br />6. Surface owners ` f <br />_ <br />7. ninerai owners I 1 I <br />?. Source of local right-tc-sneer <br />Tyke of mine/substanc= <br />10. General location i; elevation <br />I <br />11. County I I <br />I_. AGr°3Qe 1 ~ <br />l i Ce I I I! <br />I <br />14. ?resent land use <br />I <br />15. ?rcoased future use I <br />I <br />15. Sigrtac~ra <br />Haos and ::chibits <br />"cXHI81T A - Lsaal Descrioticn <br />_ <br /> <br />E;:H131T 9 - Plining ?lan i <br />~XH131T C - Nap I <br />:;<H 'a-IT D - `Ji ldl i'e, 'teats.- Aescuress, <br />`leaetatien, Scits Inforea-ion <br />