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4/77^ . <br />• <br />`SL7ED LAi•ID RECLA'?4TION <br />• <br />LI*ffTED L`1PACT aidD Sp°-CIP.L 10-DAY P_Fr?IT At7°LICATIOt1 ~'..ECXLIST <br />rile No. 7f~"'GG Name ~~~*'~~~ /© ~ Date of Filing (Completeness) <br />ITE:_ C0.`fPLcTL•' I ?aDEQLTAT-c , CO~L~~TTS <br />Application Fora <br />1. Name of operation <br />/ <br />i <br />2, Name of applicant/operator ~ <br />/ <br />3. address 6 phone (local offices) I / <br />4. Address b ahoae (general offices) <br />5. Person Co contact <br />5. Surface ocaaers I / J ~ <br />7. 2Siaeral o-~ners r <br />i <br />i <br />S. Type of mice/substance ( / <br />`/ <br />9. General location & elevation ~ / ' <br />la. County / i I <br /> ~/ <br />! <br />I2. Fee ~ //L?3 .vlt~ .,/~ ~ <br />13. ?resent load cs2 I / ~ I <br />1+. ?roposed future use / <br />Y ~if" ~ <br />~14i~ ~ <br />15. Signature ,~ <br />:pans and Extx:.bits <br />1. ~ehibit ?, - Legal descripticn <br />/ <br />2. F.-chibit B - :4iaiag plan I ~' ~ ~e/~~~ ~r~, ~,ti <br /> <br />i. Esbibit D - Svildlife, Slate esour es, <br />Regetation d Soils iaf - <br />motion <br />, <br />~ ~ <br />5. °_4hibit . - ~eclanation plan ~ ,~ ~•%, ,~ <br />