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4 / i . II I I II I II I II IIII III . MLNED LAND RECLAPfATIOPI ~ -~7 SepC ~917- <br />sss Jra `~ ; s 5 a~ <br />Rertular (112) Permit Application ChecY1 ist <br />File ado. Name Cd~y~~..er ~GSY~~sPi Date of Filing (Completeness) <br />ITEif COMPLETE ADEQUATE COMMENTS <br />Application Form <br />L Name of operation <br />2. Name of applicant ~ <br />3. Address ~ phone (local offices) / <br />4. Address 5 phone (gen'1. offices) ~/ <br />5. Person to contact ~ ,/ <br />_ <br />6. Parent corporation (if any) <br />/ i <br />7. Surface owners / <br />8. iiineral owners i / <br />9. Type of mine/substance <br />.0. General location fi elevation <br />.1. County I / I ~ <br />.2. Acreage ~/ <br />.3. Fee ~ ~ <br />_~. Present land use ~ _/ <br />.5. Surrounding land uses ~ / <br /> <br />.E. Proposed future use / <br />,/ ~ <br />.7. Other mining permits ~/ <br />L8. Signature ~/ <br />.9. Prohibite3 Lands Statement <br />*aps 6 Exhibits <br />1. Legal description <br />2. Index map / <br />3. Pre-mining 6 mining plan map ~ ~ <br />4. Paining plan'~a) timetable ~ ~ - ~j <br />- b) depth c thickness of ore - "! <br />mar,-6~ ~ j <br />sawa~~- S~ S~ ~ / ~ <br />~ .~ t,--- <br />UV4~ II V <br />