Laserfiche WebLink
4~ ~7 ~ • III IIIII~IIIIIIIIII <br />MINED LAYD RECLAMATIOi] <br />LL'1ITED L^IPACT Pu~ID SPECIAL 10-DAY PERMIT APPLICATION C°ECKI.IST <br />vile Na~'~ 7 Nacre ~1~O,ii 1 ~ Co ~` Date of Filing (Completene:cs) <br />ITE! t, <br />f" ,' CO.~LETE ADEQUATE CO~QS~ITS <br />Application Form GG7ifJrt G/z~,~ ~- ~i j <br />I. Name of operation <br />2. Name of applicant/operator <br />3. Address ~ phone (local offices) <br />4. address ~ phone (general offices) <br />5, Person to contact <br />5. Surface owners I <br />7. .fineral owners <br />8. Type of sine/substance ~ <br />9. General location ~ elevation ~ <br />I0. county 1'~ <br />11. Acreage / <br />I2. Fee ~ <br />13. Present land use <br />I4. Proposed future use ~ I <br />i <br />I5. Signature <br />Zaps and Exhibits <br />1. E::hibit A - Legal description ~/ <br />2. Exhibit B - `.fining plan I _~ <br />3. Exhibit C - .yap ~~ <br />~. Exhibit D - 'dildlife~Jater Resoufes,`~ <br />7egetatiori and Soils iafor- <br />mation ~~_ <br />5. E:chibit E - Reclasation elan I I ~. ~ .~ 4 <br /> <br />