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7/7a <br />REGULAR 112 APPLICATION <br />ITEM <br />• APPLICATION CHECKLIST <br />NAME "«~:sho.. d~:r^ FILE ,~ -ISS <br />COMPLETE (FILED) DATE ~Jrl~,.,~~ /98~L <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />I. Name of operation <br /> I ~C <br />2. Name of applicant <br /> ~~ <br />3• Address E phone, local <br />4. Address E phone, general <br /> j~ <br />5. Person to contact <br /> >c I h <br />6. Parent Corporation, if any <br /> ~L <br />7. Surface Owners <br /> t~ i <br />9. Mineral Owners ~ <br />9. Source of Legal Right-to--enter <br /> <br />10. Type of Mine/Substance <br /> ?~ ~ <br />ll. General Location E Elevation <br /> l~ K <br />12. County <br /> J'~ <br />13. Acreage <br /> k <br />14. Fee <br /> <br />15. Present Land Use <br /> <br />16. Surrounding Land Uses <br />17. Proposed Future Use <br />18. Unpermitted Mining Operations <br /> J'C <br />19. Affected Lands <br />20. Signature <br /> ~C <br />(over) <br />