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sss <br />LIMITED JnraLJ ~iiuJ <br />SPECIAL 10-DAY llll) _ <br />ITEM <br />s ~„~Gs -1 <br />APPLICATIO'J CHcCXLIST y <br />~~ ` <z~- <br />NAME Cr~~'s L,v~~t~~k C~,.~,-I~,~ FILE ~ o~~ <br />COMPLETE (FILED) DATE _ . <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of operation J~~/O 1/j~~ <br />2. Name of applicant/operator _ <br /> ~ I ~CJ _ <br />3. Address s phone, local <br />I ~ <br /> lo <br />4. Address b phone, general I <br /> <br />/O - <br />5. Person to contact _ , I <br /> f/%s' I _. <br />6. Surface owners ~ <br /> O ~ _ <br />7. Mineral owners <br />~~/o <br />8. Source of legal right-to-enter <br /> i v <br />9. Type of mine/substance <br />: <br /> ~. O I <br /> <br />10. General location 8 elevation I <br /> ~ ~/ v 1 _ <br />11 . County / l <br /> J <br />I o <br />\ - <br />12. Acreage <br />i ~ <br /> -i f p <br />13. Fee ~;b <br />_ / _ <br />14. Present Land use r / <br /> f_.) <br />15. Proposed future use <br />i ~ ` <br /> , ~ <br />16. Signature <br />~ <br />` <br />.. <br />/ <br />~ <br /> i <br />I~ / <br />/ l % <br />Maps and Exhibits --... <br />EXHIBIT A - Legal Description <br />~ D <br />=/' <br />- <br />EXHIBIT B - Mining Plan <br /> <br />EXHIBIT C - Map <br /> <br />EXH IBIT D - Wildlife, Water Resources/ allD 1, <br />2I <br />Vegetation, Soils Information I <br />