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4/77 <br />'L`IED LAND RECLAMATION • ~~ I ~ II ~ IIs11111~~ ~~~ <br />Regular (112). Permit Application Checklist <br />File 2Io. ~ Name ~ ~ ~Z .~a.a,Q Date of Filing (Completeness) <br />~Cwnrrl 7~w /e.,ti • u i ...~ <br />ITEi•S COMPLETE ADEQUATE COP4•SENTS <br />Aoplication corm <br />1. i•]ame of operation <br />`/ <br />2. ;lame of applicant ~ <br />3. Address E phone (local offices) ~/ <br />4. Address b phone (gen'1. offices) <br />~. Person to contact ~~ <br />i <br />_ <br />6. Parent corporation (if any) ~/ <br />7. Surface owners ~/ <br />3. 2Lineral owners <br />i <br />9. Type of mine/substance / <br />.C. General location S elevation <br /> <br />.1. County ~ r <br />~/ <br />I <br />~ <br />.2. Acreage ~ / I y~~ ~~ _ <br />.3. Fee <br />I <br />4. Present land use ! / ~ <br />.5. Surrounding land uses ~ / <br />.6. Proposed future use ~ <br />7. Other mining permits / <br />.8. Signature ~ <br />.9. Prohibited Lands Statement <br />"aps 6 Exhibits <br />1. Legal description <br />/ <br />2. Index map / - <br />3. Pre-mining & mining plan map <br />4. Plining plan - a) timetable ~ <br />' _ ~ <br />- b) depth b thickness of ore ~ <br />_ <br />~'Tcw~i~,.,~ <br />~ <br /> <br />body <br />