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"7 ~ ~ ~ III IIIIII~I~Iu~ ~~~ <br />~~~ ~rEn LA:SD ~ECLAr! aTlo.t 3~4~ 7 ~ <br />LL~fITED L`D?ACT A.yD SPSCT_r1I, LO-DAY PEsZ:aIT APPLICdTiOV C°..ECKLIST <br />File :da. `lame Date of Filing (Completeness): <br />IT1.~" COi~LETr i ?~EQCTATE , CO:~D vTS <br />A~nlication Fora <br /> <br />L. name of operation <br />2. :lane of applicant/operator ~ Li' <br />3. Address ~ phone (Local offices) I ~j~ <br />4. Address & phone (general offices) I ~_ f <br />.i. Person to contact i L/^ <br /> <br />5. Surface o«aers <br />1 I <br />7. :Si.aeral o•.,rners v~ ~ <br />8. Type of sine/substance / ~/' <br />'~" t <br />~ <br />I <br />9. Gznerai location 6 elevation ~ L~~ I I <br />I <br />L0. County I - I I <br />i1. Acreage I / /' <br />'~ ~ <br />IZ. Fee ~ ~ ~ <br />13. ?:eserc Land use i ~/ ~ <br /> <br />14. ?reposed futs:e use <br />~ ~ i <br />~ <br />i <br />~ <br />L5. Signature ~ <br />~aDS and E~chibits <br />L r:chibit .~ - Legal descripcica <br />y <br />I <br /> <br />Z. Exhibit B - }lining plan <br />NP~d ~/~..~- <br />ww~ i <br />3. =ahibit C - wap ' V <br />~. Exhibit D - 'dildl~ Fe, Slater c~esourees, Ne~.d 5~2G~'ETG i <br />7egecation and Sous infer- ~~,,~; idle y~_ It <br />cation ~soi t5 ~p y-~" <br /> <br />~. =.thibit L - ?eclanation pica ~ ~I <br />j ~ i I <br />