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7/7$ APPLICATION CH~CiCLIST <br />Su //J ~4r 77 <br />LIMITED IMPACT (110) ~5,. NAME (J~~k ~'~.,tY- M+~~ FILE ~ 365 <br />SPECIAL 10-DAY (111) _ COMPLETE (FILED) DATE <br />--------------------------------------------------------------------------------------------- <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application Form: <br />1. Name of operation <br />2. Name of applicant/operator <br /> <br />3- Address E phone, local <br />4. Address E phone, general <br /> Y <br />/\ <br />5. Person to contact I6t,~~~d NeW b~ eb ,~.e,tay <br />6. Surface owners <br />7. Mineral owners <br /> X <br />8. Source of legal right-to-enter <br />9. Type of mine/substance <br /> <br />10. General location 6 elevation <br />ll. County <br />12. Acreage x Nco~l ~ reef flc rra5~ <br /> ~ <br />13. Fee <br /> <br />14. Present land use <br />15. Proposed future use <br /> ~ <br />16. Signature <br />Maps and Exhibits __ <br />EXHIBIT A - Legal Description <br /> x i <br /> M~s+ ~r t.~~~lcr ro. <br />EXHIBIT B - Mining Pian 'f{ ffP.red ~-a-.J"" M..:r 5e <br /> ~ u.-. ~~v /oFar (l0. <br />EXHIBIT C - Map <br />J / <br />EXH IBIT D - Wildlife, Water Resources, <br />Vegetation, Soils Information <br />