Laserfiche WebLink
4/77 ~--- <br />III IIIIIIIIIIIII III ~ MINED LAND RECLAMATION ~C~I< ~ <br />Regular (112) Permit Application Checklist <br />f r~C, <br />File Vo.~~ ~S.~Name/S~~I2~~-T/NE T/yyfSTit7!-r;" ~/ Late of Filing (Completeness): <br />7'/~ 77 <br />ITEi•? ~G'G L!~ N7~J ~'~qr/ Tom/ T ~ ~ COMPLETE ADEQUATE COPII-TENTS <br />Application Form <br />1. flame of operation <br />~_ <br />2. ..\Tame of applicant //' ~ <br />3. Address ~ phone (local offices) V ~ 1 <br />4. Address ~ phone (gen'1. offices) L- ~ <br />5. Person to contact ~ V <br />i ~- <br />_ <br />6. Parent corporation (if any) <br />~ ~ <br />7. Surface owners L'- <br /> <br />3. Piineral owners i <br />~/'"~ i <br />9. Type of mine/substance ~ ~ L-' f/~N,~ 4t. <,'i~.~(J~ C <br />.O. General location 6 elevation ~~~~ art ~~~ ~ <br />i <br />.1. County ~ <br />~I ~~ ' <br />.2. Acreage lam-- I ~- I ~- <br />,d• ~ <br />.3. Fee i ~ ~ A <br />`~ ~ ~'! ~~=' ~ So°•, <br />u ;, <br />L4. Present land use ~ ~~ ~- ~ <br />.5. Surrounding land uses ~ L- <br />Lo. Proposed future use ~-~ i <br />U. Other mining permits l ~- <br />L8. Signature ~ ~---- <br />L°. Prohibited Lands Statement '~ ~~ <br />'.aps S Exhibits <br />1. Legal description <br />~- <br />2. Index map ~ ~"~ <br />3. Pre-mining & mining plan map ~ v <br />i <br />4. ''Pfining plan - a) timetable ~ <br />~i Vii, ~ <br />- b) depth & thickness of ore j ~°u~ ~C'no2o5e~ <br />~~ <br />ooay _~~~crtl-Se ~~ ~~ <br />