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4/77 ~JIJf JJ~I'~~ I.MLIED LAND RECLAa~1ATION ~ ~j ~~` ..qq W'' <br />ReQU1ar (I12) Permit Application Checklist % ~/°~~v <br />File :•lo. __ Name ~ ~~-Ci..Q ~ru~e.~ t'~~-" ~""' Date of Filing (Completeness) :_ <br />ITEi•f COMPLETE ADEQUATE COt•4fENTS <br />Application Form <br />1. Name of operation <br />2. ;lame of acpplicant <br />3. Address t: phone (local offices) I / <br />4. Address ~r phone (gen'L. offices) / <br />S. Person t~~ contact ~ / <br />i <br />6. Parent corporation (if any) / <br />7. Surface owners .~ <br />3. Piineral owners <br />i ~ <br />i <br />9. Type of mine/substance <br />,0. General location & elevation <br /> <br />,1. County ~ <br />~ / I <br />i ~ <br />L2. Acreage ~ <br />L3. Fee ~ '~ <br />i <br />L4. Present land use ~ / ~ <br />L5. Surrounding land uses i <br />L6. Propose,l future use ~ <br />L7. Other m:Lning permits <br />LS. Signature / ~ <br />L9. Prohibited Lands Statement <br />naps & Exhibits <br />1. Legal description <br /> <br />2. Index map / <br />/ <br />3. Pre-mining c. mining plan map <br /> <br />4. Mining elan - a) timetable I / <br />,/ <br />- b) depth ti thickness of ore ~ I <br />body <br />