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7/78 APPLICATION CHECKLIST <br />SPECIAL IOPDAY (1110) ~ • COMPLETE (FILED) DATE III IIIIIIIIIIIIIIII~ <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: 'Z <br />1. Name of operation <br />\ <br />2. Name of applicant/operator / <br />3. Address b phone, local <br />4. Address b phone, general <br />5. Person to contact / <br />6. Surface owners I/ <br />7, Mineral owners / <br />8. Source of legal right-to-enter <br />9. Type of mine/substance / <br />10. General location 6 elevation <br />11. County <br />12, Acreage <br />13, Fee ~ <br />14. Present land use <br />15. Proposed future use ~ <br />16. Signature <br />Maps and Exhibits <br />EXHIBIT A - Legal Description <br /> <br />>/ <br /> <br />L_; ~. _ <br />EXHIBIT B - Mining Plan <br />EXHIBIT C - Map V <br />EXH IBIT D - Wildlife, Water Resources, <br />Vegetation, Soils Information / // <br />