PERMFILE63384

• Permit No: M1977310
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT AND SPECIAL 10 DAY PERMIT APPLICATION CHECKLIST
• Section_Exhibit Name: EXHIBIT A
• Media Type: D
• Archive: No

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MIbTED LAi~ID RECLAMATION
LIMITED L*iPACT ALW SPECIAL 10-DAY PERi•!IT APPLICATION C'3ECKLIST
File No.7 7'30 Name C ~f.~ r. C~.~~ T ~ ~ Date of Filing (Completeness):
ITEM CO:SPLETE ADEQUATE COMME<ZTS
Application Form
1. Name of operation
v
2. Name of applicant/operator v
3. Address 6 phone (local offices}
4. Address & phone (general offices) (~
5. Person to contact
6. Surface ocmers ~/ I
7. Aiineral owners
S. Type of mine/substance
9. General location ~ elevation
10. County
11. Acreage
12. Fee
I3. Present land use
14. Proposed future use
15. Signature
daps and Exhibits
1. Exhibit A - Legal description , /
V
2. Exhibit B - :lining plan
3. Exhibit C - Map
4. Exhibit D - Wildlife, Water Resources,
Vege ation and Soil infor-
mation
v/ "''~`"` R~`° ~~'""`

~. Exhibit E - Reclamation plan
// ~~
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