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4/77 • <br /> <br />MLYED LAND RECLAMATIOtI <br />File No. ~~ <br />- hit Date of Filing (Completeness): <br />ITEM COi1PLETE ADEQUATE COM4fEiTLS <br />Application Form <br />1. Name of operation <br />/ <br />V <br />J <br />P~1. <br />Y L <br />2. Name of applicant/operator / / <br />3. Address b phone (local offices} ~/ <br />4. Address & phone (general offices) <br />5. Persoa to contact / J <br />6. Surface owners V I <br />7. .fineral owners ~ <br />S. Type of mine/substance <br />9. General location 6 elevation <br />10. County <br />11. Acreage <br />y <br />trln 5crtpdna <br />w/ Ors C, 0. <br />12. Fee <br />13. Present land use ~/ <br />l4. Proposed future use / <br />15. Signature <br />Maps and Exhibits <br />1. Exhibit A - Legal description <br />2. Exhibit B - ;Siring plan <br />3. Exhibit C - Map <br />4. Exhibit D - Wildlife, idater Resources, <br />Vegetation and Soils infor- <br />mation <br /> <br />~. Exhibit E - Reclamation plan / <br />V <br /> <br />