PERMFILE57779

• Permit No: M1981108
• IBM Index Class Name: Permit File
• Doc Name: APPLICATION CHECKLIST
• Media Type: D
• Archive: No

]/7a • APPL I CAT 10:! Ci'.-cC~<L I ST 111 III1111111111111 ~~-
LIMITED InPACT (110) !~\ NAME `~,~,fa ~~;o~iP7_ sss r ~~,
SPECIAL 10-OAY (111) _. COMPLETE (FILED) DATE
ITEM COMPLETE ADEi)UaTE COMMENTS
Aoolication Form:
1. Name of operation
2. Name of applicant/operator ~ I
3. Address E phone, local I
4. Address G phone, general
5. Person to contact j
6. Surface owners
7. Mineral owners
8. Source of legal right-to-enter
!
9. Type of mine/substance
I ~
10. General location E ele~iation
11. County f
12. Acreage
13. Fee I
14. Present land use
15. Proposed future use ~ I
I
16. Signature
Maps and Exhibits
EXHIBIT A - Legal Description
~ )
J _ ._
EXHIBIT B - Mining Pian V'

EXHIBIT C - Map i
J
EXH IBIT D - Wildlife, Water Resources,
Vegetation, Sails Info oration