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__ _--- <br />4/77} IIII ~ ~~~~~~~~~~ ~ ~ <br />MLNED LAPID AECLAPfATI0P7 <br />~y"y~~LIMITED~~II"•IPACnT,,AND S/P~E~CI~A•L,y10-DAY PERMIT APPLICATION CHECKLIST <br />File No. ~ 1 ah7 Name [~70~ WI.L~~uN Kk1'• ~e~K-. Date of Filing (Completeness) :, <br />ITEM COMPLETE ADEQUATE COMt1EiTTS <br />Application Form <br />I. Name of operation <br />~ <br />p'~ <br />1-~ <br />2. Name of applicant/operator ~ <br />3. Address & phone (local offices) <br />4. Address & phone (general offices) <br />5. Person to contact <br />6. Surface owners <br />7. Pfineral owners J <br />8. Type of mine/substance <br />9. General location S elevation <br />10. County / <br />11. Acreage <br />12. Fee <br />13. Present land use <br />14, Proposed future use <br />15. Signature ~/ <br />Maps and Exhibits <br />1. Exhibit A - Legal description <br />1~ <br />2. Exhibit S - ~Sining plan ~/ <br />3. Exhibit C - Map ~/ <br />4. Exhibit D - Wildlife, Slater Resources, <br />Vegetation and Soils infor- <br />mation <br />5. Exhibit E - Reclamation plan <br />